Der Einfluss der Therapie von koexistentem Vorhofflimmern auf das Überleben von Patienten nach erfolgreicher perkutaner Mitralklappenrekonstruktion
Hintergrund: Die perkutane Mitralklappen-Rekonstruktion mittels Edge-to-Edge-Repair (TEER) ist eine etablierte Behandlungsmethode in der Therapie der hochgradigen Mitralklappeninsuffizienz (MI) bei inoperablen Hochrisiko-Patienten. Vorhofflimmern (VHF) stellt hierbei eine relevante Nebenerkrankung d...
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| Format: | Doctoral Thesis |
| Language: | German |
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Philipps-Universität Marburg
2022
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| Online Access: | PDF Full Text |
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Background: Percutaneous mitral valve repair using edge-to-edge repair (TEER) is an established treatment method for high-grade mitral regurgitation (MR) in inoperable high-risk patients. Atrial fibrillation (AF) is a relevant concomitant disease, which significantly worsens the long-term prognosis despite adequate valve reconstruction. However, the impact of underlying atrial fibrillation therapy on long-term survival remains unclear. Methods: In this multicenter observational cohort study in a TEER collective of 542 MI patients, survival analysis was performed in patients with and without preexisting AF as well as in AF patients under rhythm versus rate control. In order to account for differences in clinical characteristics and independent mortality predictors, cohorts were adjusted by propensity score matching (PSM). Results: 73% of the cohort (373/506) showed a pre-existing AF, which was mostly treated by rate control [59% (212/373)]. After PSM, there was a statistically significant lower 3-year survival rate in AF patients compared to non-AF patients [47.3% (126/266) vs. 58.3% (78/133); HR 1.4; 95% CI 1.004-2.03; p=0.047]. Rhythm control was associated with significantly lower survival rates at three years compared to rate control [46.7% (75/161) vs. 56.5% (91/161); HR 1.5; 95% CI 1.03-2.06, p=0.032]. Amiodarone was used extensively for rhythm control of AF and proved to be a significant predictor of mortality [HR 1.5; 95% CI 1.1-2.1; p=0.04]. Conclusion: Therapy of concomitant AF was mainly achieved by using pharmacological treatment strategies. In this context, rhythm-controlled AF patients showed a significantly higher mortality rate compared to rate-controlled patients. Amiodarone represented the most commonly used antiarrhythmic drug with a significant association to long-term mortality. Prospective studies are needed to evaluate the use of amiodarone for rhythm control of concomitant AF in this elderly and multimorbid collective.