Study Links Atrial Fibrillation and Heart Failure to Poor Mitral Valve Repair Outcomes

Recent findings from the Mount Sinai Fuster Heart Hospital reveal a significant correlation between the presence of atrial fibrillation (AF) and adverse outcomes following mitral transcatheter edge-to-edge repair (M-TEER) in patients suffering from severe mitral regurgitation. The research, published on July 17, 2025, in the Journal of the American Heart Association, indicates that patients with both heart failure and AF at the time of M-TEER are more than twice as likely to experience death or rehospitalization for heart failure compared to those without AF.

The study analyzed 156 patients, of whom 38% presented with AF prior to the procedure. Despite similar procedural success rates between the two groups, patients with AF exhibited significantly worse outcomes in the months following the intervention. Specifically, more than 52% of AF patients were either rehospitalized for heart failure or had died within two years, compared to 33% in the non-AF group. Additionally, AF patients were more likely to experience a recurrence of valve leakage and showed no improvement in heart size post-procedure.

Dr. Stamatios Lerakis, a leading researcher and Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, emphasizes the need for aggressive treatment of AF prior to procedures like M-TEER. "AF is a powerful risk marker that we need to take into consideration when planning and performing these procedures," Dr. Lerakis stated. This sentiment is echoed by Dr. Gregg W. Stone, also a Professor of Medicine at the Icahn School of Medicine, who highlights the importance of early intervention for heart failure and mitral regurgitation to prevent the development of AF.

Mitral regurgitation is the second most common valvular heart disease, affecting over two million adults in the United States. It occurs when the mitral valve fails to close completely, causing blood to leak backward into the heart. The minimally invasive M-TEER procedure aims to repair this valve issue by clipping its leaflets together. However, the interplay between mitral regurgitation and AF complicates treatment and outcomes.

The study's findings stress the interconnected nature of these conditions and point to the necessity for further research into optimal management strategies for patients undergoing M-TEER. Dr. Carlo Mannina, a cardiology fellow at Mount Sinai Morningside, noted the need for larger studies to validate these findings and explore the implications of AF in patients receiving M-TEER. The researchers hope that their work will prompt more proactive treatment approaches in this vulnerable patient population.

Overall, the study underscores the critical need for healthcare providers to recognize the prognostic impact of AF in patients with severe mitral regurgitation and heart failure, especially as transcatheter heart procedures become increasingly common. It suggests a paradigm shift towards preoperative rhythm control and highlights the importance of multidisciplinary care in managing complex cardiac conditions.