Atrial Fibrillation and Clinical Outcomes Following Mitral Transcatheter Edge-to-Edge Repair According to Mitral Regurgitation Etiology
BACKGROUND: The association between atrial fibrillation (AF) and prognosis after mitral transcatheter edge-to-edge repair (M-TEER) remains unclear. OBJECTIVES: The authors examined the association between AF and clinical outcomes after M-TEER according to the etiology of mitral regurgitation (MR). METHODS: A total of 3,764 patients were classified into degenerative mitral regurgitation (DMR), ventricular functional mitral regurgitation (VFMR), and atrial functional mitral regurgitation (AFMR). We further stratified the patients by the presence of AF. The primary outcome was all-cause mortality within 2 years. RESULTS: The prevalence of AF was 57.4% (n = 646 of 1,126) in DMR, 59.7% (n = 1,319 of 2,211) in VFMR, and 83.8% (n = 358 of 427) in AFMR. During 2-year follow-up (the median follow-up: 427 [IQR: 301-821] days), 660 of 3,764 patients (17.5%) died. The association between AF and all-cause mortality had a significant interaction with MR etiology (P for interaction <0.001). AF was associated with a higher risk of all-cause mortality in DMR (adjusted HR: 1.88; 95% CI: 1.17-3.02; P = 0.009), whereas this association was not significant in VFMR and AFMR. Among patients with VFMR, left atrial (LA) volume index modified the association between AF and all-cause mortality. AF was related to a higher risk of all-cause mortality in VFMR patients with lower LA volume index, whereas this association was attenuated in those with higher LA volume index. CONCLUSIONS: AF was associated with all-cause mortality after M-TEER in patients with DMR, but not in those with VFMR or AFMR. The prognostic effect of AF in patients undergoing M-TEER may be modulated by MR etiology and underlying LA remodeling.
Authors
- Shingo Kuwata (ORCID: https://orcid.org/0000-0001-5378-0205)
- Yusuke Enta (ORCID: https://orcid.org/0000-0003-1931-1012)
- Kazuki Mizutani (ORCID: https://orcid.org/0000-0001-7206-4538)
- Taishi Okuno (ORCID: https://orcid.org/0000-0001-7831-2934)
- Shingo Mizuno (ORCID: https://orcid.org/0009-0009-6030-2418)
- Kazuhisa Kodama
- Mike Saji (ORCID: https://orcid.org/0000-0003-2057-109X)
- Daisuke Hachinohe (ORCID: https://orcid.org/0000-0003-4828-1836)
- Yohei Ohno (ORCID: https://orcid.org/0000-0003-4203-7613)
- Masahiko Asami
- Masahiro Yamawaki
- Masaki Izumo
- Hiroki Bota
- Yuki Izumi
- Shinichi Shirai (ORCID: https://orcid.org/0000-0002-4764-8205)
- Junichi Yamaguchi
- Hiroshi Ueno
- Masanori Yamamoto
- Yusuke Watanabe (ORCID: https://orcid.org/0000-0003-2297-5303)
- Yoshihiro J. Akashi
- Shunsuke Kubo
- Toshiaki Otsuka
- Kentaro Hayashida (ORCID: https://orcid.org/0000-0002-1750-1982)
- Makoto Amaki
- Tetsu Tanaka (ORCID: https://orcid.org/0000-0003-0780-8689)
- Toru Naganuma
- Daisuke Miyahara
Institutions
- Twitter (United States) (US)
- Tokai University (JP)
- St. Marianna University School of Medicine (JP)
- Keio University (JP)
- Kurashiki Central Hospital (JP)
- Sapporo Higashi Tokushukai Hospital (JP)
- New Tokyo Hospital (JP)
- Saiseikai Kumamoto Hospital (JP)
- Sapporo Science Center (JP)
- National Cerebral and Cardiovascular Center (JP)
- Toyohashi Heart Center (JP)
- Sakakibara Hospital (JP)
- Mitsui Memorial Hospital (JP)
- Tokyo Women's Medical University (JP)
- Toyama University Hospital (JP)
- Shonan Kamakura General Hospital (JP)
- Saiseikai Yokohama Eastern Hospital (JP)
- Kokura Memorial Hospital (JP)
- Nippon Medical School (JP)
- Teikyo University (JP)
- Kindai University (JP)
Publication Details
- Journal
- JACC Asia
- Published
- 2026-05-01
- DOI
- https://doi.org/10.1016/j.jacasi.2026.02.028
- Primary Topic
- Cardiac Valve Diseases and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Abbott Laboratories
- Edwards Lifesciences
- Boston Scientific Corporation
- Medtronic
- Daiichi Sankyo Company