Adabag, Selcuk

ABSTRACT Background The available risk prediction models are inadequate to identify a true low‐risk patient for developing new‐onset atrial fibrillation (AF) after typical atrial flutter (AFL) ablation. We aimed to determine whether adding markers of atrial myopathy to HATCH score ( h ypertension, a ge ≥75 years, t ransient ischemic attack/stroke, c hronic obstructive pulmonary disease, and h eart failure) can improve prediction of new‐onset AF after ablation of typical AFL. Methods The study included 208 consecutive patients who underwent successful ablation of typical AFL at Minneapolis VA Medical Center and University of Minnesota Medical Center. Patients with history of AF prior to ablation were excluded. Results Among the 208 patients, 76 (36.5%) developed new‐onset AF post AFL ablation. Mean follow‐up duration was 62 ± 31.8 months. HATCH score was not associated with new‐onset AF. When adding atrial myopathy (presence of at least one of the following: PTFV 1 > 5000 µV*ms, interatrial block determined by biphasic inferior p wave with duration >120 ms, left atrium (LA) diameter ≥44 mm, or LA index ≥3 cm/m 2 ) to HATCH score (HATCH‐A 2 ), the combination was independently associated with new‐onset AF. The AF incidence between HATCH‐A 2 score of 0–1 and ≥2 were 6.7% and 40.5%, respectively (Odds ratio 9.04, 95% confidence interval: 2.05–39.81, p = 0.004). Particularly, when HATCH‐A 2 score was 0, none of the patients developed AF. Conclusions Adding atrial myopathy to HATCH score improved predictability and could be used to delineate a true low‐risk patient of new‐onset AF after typical AFL ablation.

BackgroundThe MitraClip® system is a newer percutaneous device that has shown promising results but data on its safety and efficacy in low‐ and high‐surgical risk populations continues to evolve. We performed a systematic review of the published studies reporting the safety and efficacy of MitraClip® implantation for treatment of moderate to severe and severe mitral regurgitation (MR).MethodsReviewers independently searched for relevant articles in Medline and abstracted clinical information based on pre‐defined criteria and end‐points. Patients were classified as low‐ or high‐surgical risk for conventional mitral valve (MV) surgery based on Society of Thoracic Surgeons score, EuroSCORE, or surgeon discretion. Primary safety outcome was 30‐day mortality and primary efficacy outcomes were freedom from death, ≥3+ MR, and requirement for MV surgery during follow‐up.ResultsImmediate and long‐term outcomes of 16 studies, including 2980 patients (age 73.7 ± 0.6 years; 63.3% males) receiving the MitraClip®, were analyzed. Acute procedural success rate was 91.4% with a procedural mortality of 0.1%. Mortality at 30 days and long‐term (310 days) follow‐up was 4.2 and 15.8%, respectively and was significantly higher in the high‐risk group (P = 0.003 and 0.019, respectively). Incidence of major procedural adverse outcomes was relatively low with blood transfusion accounting for most events. At follow‐up, the number of patients with ≥3+ MR reduced from 96.3% to 14.7% (P < 0.001), and those with NYHA class III/IV reduced from 83.2% to 23.4% (P < 0.001).ConclusionMitraClip® implantation for moderate to severe or severe MR appears to be safe with a very low procedural mortality. There is significant improvement in functional outcomes although long‐term mortality is high, especially in high surgical risk patients. © 2013 Wiley Periodicals, Inc.