Abstract 16806: Transcatheter Edge-to-Edge Repair Lessens Atrial Fibrillation Burden by Ameliorating Left Atrial Strain in Moderate-to-Severe Mitral Regurgitation Patients

Introduction: trans-catheter edge-to-edge repair (TEER) represents a therapeutic possibility in patients with moderate-severe mitral regurgitation (MR) considered at high surgical risk. Only in recent years, it has been realized that left atrial (LA) function plays a prognostic role in these patients.

Hypothesis: since atrial fibrillation (AF) depends in part on LA geometry, we considered that two-dimensional speckle-tracking-echocardiography analysis could predict AF burden.

Aim: we therefore evaluated the AF occurrence long term after TEER.

Methods: one hundred nine patients treated by TEER between February ‘15 and April ’22 underwent reservoir (R_s), conduct (D_s), and contractile (C_s) evaluations strains before and 1,6,12 months after TEER. Cardiac rhythm was monitored through 24 hours Holter-ECG or previously implanted cardiac devices, when available. Statistical analysis was performed with SPSS. Comparisons were carried out by ANOVA and MANOVA.

Results: to the permanent AF group (n=35), no paroxysmal (N=15), nor persistent (N=8) case was added during follow-up after TEER. Among the sinus rhythm (N=51) group, one episode of atrial tachyarrhythmia was found at device interrogation and one patient developed paroxysmal AF (2/51; 3,9%). Significant improvements in total cohort were observed at 12 months follow-up for R_s (from 10,77±5,74% to 16,28±6,93%; p<0,0001), D_s (from -6,72±4,44% to -9,73±4,48%; p=0,0003) and C_s (from -5,21±5,11% to 7,72±5,4%; p=0,0184) compared to baseline. AF burden in paroxysmal AF (baseline: 9,2±4,7 hours, follow-up: 5,8±4,2 hours; p<0,001) was significantly reduced as well as ventricular rate (baseline 88±14 bpm; 12 months 76±13 bpm; p<0,001) in permanent AF group.

Conclusions: MR reduction following TEER dictates positive LA remodelling and significant improvement of LA strain. Overall, the impact on LA geometry contributed to lessen incidence and burden of AF.