AF Worsens Outcomes After Heart Valve Repair

Atrial Fibrillation Doubles Risk of Death or Rehospitalization Post-M-TEER

Patients undergoing a minimally invasive procedure to fix severe leaky heart valves face a significantly higher risk of death or heart failure rehospitalization if they also have atrial fibrillation (AF), according to new research.

AF a Major Prognostic Factor

A study from Mount Sinai Fuster Heart Hospital reveals that individuals with atrial fibrillation at the time of mitral transcatheter edge-to-edge repair (M-TEER) for severe mitral regurgitation are more than twice as likely to experience adverse events compared to those without AF. This finding highlights the critical role of AF as a powerful predictor of outcomes after the procedure.

“We found that even when the transcatheter mitral valve procedure is successful, having atrial fibrillation at the day of the procedure doubles the risk of death or rehospitalization for heart failure. AF is a powerful risk marker that we need to take into consideration when planning and performing these procedures. We know that mitral regurgitation and AF are interconnected. The one begets more of the other and vice versa. This study suggests that rhythm control ahead of time may be critical for the outcome of patients undergoing these procedures.”

—Stamatios Lerakis, MD, PhD, Corresponding Author, Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai

“Our study emphasizes the importance of atrial fibrillation as a major prognostic factor in patients with heart failure and severe mitral regurgitation, even after effective transcatheter edge-to-edge repair,” stated **Gregg W. Stone**, MD, Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. “These findings support early treatment of heart failure and mitral regurgitation before atrial fibrillation develops, in addition to considering ablation should atrial fibrillation occur.”

Understanding Mitral Regurgitation and AF

Mitral regurgitation, the second most prevalent valvular heart disease in the U.S. affecting over 2 million adults, occurs when the mitral valve doesn’t seal properly, causing blood to flow backward. This increases heart pressure and the risk of hospitalization and mortality. M-TEER, a less invasive clipping technique, is a common treatment.

Atrial fibrillation, characterized by a rapid, irregular heartbeat, affects up to a third of individuals with mitral regurgitation. The Mount Sinai study aimed to clarify M-TEER’s impact on patients with co-existing AF.

Study Methodology and Findings

Researchers analyzed 156 patients with symptomatic heart failure and severe mitral regurgitation who underwent M-TEER. Thirty-eight percent of these patients had AF at the time of the procedure, while 62% did not. The study tracked survival, heart failure admissions, and cardiac function over more than a year.

While M-TEER demonstrated similar success rates in both groups, patients with AF experienced poorer outcomes. Within two years, over 52% of AF patients faced death or rehospitalization for heart failure, compared to 33% of those without AF. Additionally, AF patients showed less heart recovery and a higher rate of recurrent valve leakage (19% vs. 8%).

“This definitely needs further investigation,” commented **Carlo Mannina**, MD, a cardiology fellow at Mount Sinai Morningside. He noted that while this is a single-center study with a modest sample size, it effectively highlights a significant clinical challenge.

The prevalence of AF in the U.S. is increasing, with estimates suggesting that over 12 million Americans will have AF by 2030, underscoring the growing importance of understanding its impact on cardiovascular interventions (CDC).