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Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growin...

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Autores principales: Waechter, Christian, Ausbuettel, Felix, Chatzis, Georgios, Cheko, Juan, Fischer, Dieter, Nef, Holger, Barth, Sebastian, Halbfass, Philipp, Deneke, Thomas, Kerber, Sebastian, Kikec, Jan, Mueller, Hans-Helge, Divchev, Dimitar, Schieffer, Bernhard, Luesebrink, Ulrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584691/
https://www.ncbi.nlm.nih.gov/pubmed/34768567
http://dx.doi.org/10.3390/jcm10215044
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author Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Kerber, Sebastian
Kikec, Jan
Mueller, Hans-Helge
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
author_facet Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Kerber, Sebastian
Kikec, Jan
Mueller, Hans-Helge
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
author_sort Waechter, Christian
collection PubMed
description Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1–2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients.
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spelling pubmed-85846912021-11-12 Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair Waechter, Christian Ausbuettel, Felix Chatzis, Georgios Cheko, Juan Fischer, Dieter Nef, Holger Barth, Sebastian Halbfass, Philipp Deneke, Thomas Kerber, Sebastian Kikec, Jan Mueller, Hans-Helge Divchev, Dimitar Schieffer, Bernhard Luesebrink, Ulrich J Clin Med Article Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1–2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients. MDPI 2021-10-28 /pmc/articles/PMC8584691/ /pubmed/34768567 http://dx.doi.org/10.3390/jcm10215044 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Kerber, Sebastian
Kikec, Jan
Mueller, Hans-Helge
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_full Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_fullStr Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_full_unstemmed Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_short Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_sort impact of rhythm vs. rate control in atrial fibrillation on the long-term outcome of patients undergoing transcatheter edge-to-edge mitral valve repair
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584691/
https://www.ncbi.nlm.nih.gov/pubmed/34768567
http://dx.doi.org/10.3390/jcm10215044
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