The Critical Role of Heart Rhythm Control Before Mitral Transcatheter Repair

Recent research highlights the significant impact of atrial fibrillation (AF) on outcomes for patients undergoing mitral transcatheter edge-to-edge repair (M-TEER) for severe mitral regurgitation. Patients presenting with AF at the time of the procedure are more than twice as likely to experience death or hospitalization due to heart failure within two years post-procedure, compared to those without AF. This insight stems from a study conducted at Mount Sinai Fuster Heart Hospital, which analyzed 156 patients with symptomatic heart failure and severe mitral regurgitation treated with M-TEER. Participants were divided based on the presence or absence of AF at the time of intervention, and their recovery was tracked over a median follow-up of over a year using echocardiography and clinical assessments.

While the success rate of the procedure was similar across both groups, patients with AF faced worse outcomes. They experienced higher rates of recurrent valve leakage, less heart size reduction, and increased rehospitalizations or mortality—more than 52% compared to 33% in patients without AF. Moreover, these patients showed limited heart recovery and a higher incidence of severe valve regurgitation reappearing.

The study underscores the importance of managing atrial fibrillation proactively before performing M-TEER. Dr. Stamatios Lerakis, the study’s lead author, emphasizes that AF should be considered a major risk marker that influences treatment planning. The findings suggest that rhythm control strategies, including early intervention for AF, could improve patient prognosis. This is particularly relevant because mitral regurgitation, affecting over two million adults in the U.S., often co-occurs with AF, further complicating patient outcomes.

Mitral regurgitation involves the backward leakage of blood due to valve dysfunction caused by an enlarged left ventricle. The minimally invasive M-TEER procedure effectively clips the mitral valve leaflets, reducing leakage and symptoms. However, the presence of AF appears to hinder the full benefits of this intervention. The study's authors advocate for early treatment of heart failure and mitral valve pathology, along with consideration of atrial fibrillation ablation, to enhance long-term outcomes. Further research is needed to confirm these findings and optimize treatment protocols.

This research emphasizes that targeted management of atrial fibrillation is crucial for improving the success of mitral valve interventions and reducing subsequent heart failure complications.

Source: https://medicalxpress.com/news/2025-07-emphasizes-importance-heart-rhythm-mitral.html