Effects of atrial fibrillation on treatment of mitral regurgitation in the everest ii (endovascular valve edge-to-edge repair study) randomized trial Full Text
JACC - Journal of the American College of Cardiology, 04/12/2012
Herrmann HC et al. – Atrial fibrillation is associated with more advanced valvular disease and noncardiac comorbidities. However, acute procedural success, safety, and 1–year efficacy with MitraClip therapy is similar for patients with AF and without AF.Methods
- The study population included 264 patients with moderately severe or severe MR assessed by an independent echocardiographic core laboratory.
- Comparison of safety and effectiveness study endpoints at 30 days and 1 year were made using both intention–to–treat and per–protocol (cohort of patients with MR 2+ at discharge) analyses.
- Pre–existing AF was present in 27% of patients.
- These patients were older, had more advanced disease, and were more likely to have a functional etiology.
- Similar reduction of MR to 2+ before discharge was achieved in patients with AF (83%) and in patients without AF (75%, p = 0.3).
- Freedom from death, mitral valve surgery for valve dysfunction, and MR >2+ was similar at 12 months for AF patients (64%) and for no–AF patients (61%, p = 0.3).
- At 12 months, MR reduction to <2+ was greater with surgery than with MitraClip, but there was no interaction between rhythm and MR reduction, and no difference in all–cause mortality between patients with and patients without AF.