https://doi.org/10.1007/s00392-024-02526-y
1Ostalb-Klinikum Aalen Innere Medizin II, Kardiologie und Angiologie Aalen, Deutschland; 2Ostalb-Klinikum Aalen Pädiatrie Aalen, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland
Background
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia linked with significant morbidity and mortality. Mitral regurgitation (MR) often coexists with AF, potentially complicating treatment outcomes. Understanding how MR severity influences the efficacy and safety of pulmonary vein isolation (PVI) in AF patients is essential for optimizing therapeutic strategies.
Methods
This study included 166 patients, divided into two groups based on MR severity: moderate or severe MR (n=83) and no or mild MR (n=83). The control group was matched using propensity scores based on age, gender, and BMI to ensure comparability. Baseline clinical data, procedural parameters, and complications were collected and analyzed statistically.
Results
There were no significant differences in baseline demographics between the two groups. Notably, patients with moderate to severe MR had a higher proportion of atrial fibrosis (23.06% vs. 15.42%, p=0.04). Procedural parameters were similar in both groups, including procedure duration (111.3 ± 31.67 minutes vs. 111.2 ± 33.82 minutes, p=0.97), fluoroscopy time (13.28 ± 6.95 minutes vs. 12.22 ± 6.85 minutes, p=0.18), and dose area product (1287 ± 1149 cGycm² vs. 1119 ± 900.4 cGycm², p=0.65). A significant difference was found in the frequency of additional ablation lines, especially CTI ablation in patients with concomitant typical atrial flutter (18.07% vs. 6.02%, p=0.02). Clinical outcomes showed that the recurrence rate of AF after one year was identical in both groups (19.28% each, p=1.00). No major complications occurred, and minor complications were more common in the moderate to severe MR group, but the difference was not significant (6.02% vs. 2.41%, p=0.44).
Conclusion
These results demonstrate that pulmonary vein isolation can be performed safely and effectively in patients with AF, regardless of MR severity. Patients with moderate to severe MR exhibited a higher rate of atrial fibrosis and required more additional ablations, indicating a more complex disease state. However, long-term outcomes regarding AF recurrence were similar in both groups.