"Persistent Moderate and Severe Mitral Regurgitation is Associated With" by Jonathan S. Gordon, Fernando Moreno et al.
 

Persistent Moderate and Severe Mitral Regurgitation is Associated With Lower Clinical Efficacy After Atrial Fibrillation Catheter Ablation: The Multicenter Persistent-AF Registry

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Heart Rhythm

Abstract

Introduction: Atrial fibrillation(AF) and mitral regurgitation(MR) are closely linked conditions. MR increases AF risk by promoting LA dilation and electrical remodeling. The effectiveness of catheter ablation(CA) in this population is not well-defined. Methods: In this retrospective multicenter study conducted Jun 2010-Nov 2024, 106 pts with persistent moderate/severe MR (MR+ group) on post-CA echocardiograms in sinus rhythm (SR), were compared to a 1:1 propensity-matched control group(pool 887 pts) with mild/no MR (MR- group) who underwent AF CA (matching age, gender, BMI, persistent AF, DM, AADs, stroke/ TIA, HF, OSA, LVEF, HTN, CAD, severity LA dilation using nearest-neighbor algorithm w/ 0.2 caliper). The primary outcome was composite of atrial arrhythmias and redo-ablation. Secondary outcomes were recurrence of AF, AFL, and redo-ablation. Results: 106 cases were matched with 106 controls with no imbalance on matching comorbidities. Procedural complications were similar between groups. Use of AAD drugs after 90-day blanking period was similar (29% vs 25%;p=0.4). Primary composite endpoint occurred more frequently in MR+ group on follow up (Figure A; p=0.009). AF recurrence occurred in 31/106 (29%) MR- vs 51/106 (48%) MR+ pts(Figure B, p= 0.01), AFL/ atach occurred in 12/106(11%) MR- vs 23/106 (22%) MR+ pts(p=0.05), redo-ablations in 20/106 (19%) MR- vs 38/ 106(36%) MR+ pts(p=0.006). Application: This is the first multicenter comparative head-tohead study to demonstrate persistent ≥ moderate MR despite maintenance of SR after AF CA is associated with lower long term clinical efficacy suggesting importance of appropriate patient selection and concomitant treatment of MR. Next Steps/Future: RCTs are needed to evaluate whether pts with . moderate MR would derive greater benefit from AF CA plus mitral valve intervention versus AF CA alone.

Volume

22

Issue

4 Suppl

First Page

S795

Comments

Heart Rhythm Society Annual Meeting, April 24-27, 2025, San Diego, CA

Last Page

S796

DOI

10.1016/j.hrthm.2025.03.1911

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