An under-recognized high-risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

Objective: Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Background: Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co-morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. Methods: We conducted a single-center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. Results: AF was present in 122 (62%) of TMVR patients with an average CHA2DS2-VASc score of 3.99. 23% of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty-three and 47% of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS-BLED score. 50% of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Conclusion: Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.