Impact of transcatheter mitral valve edge-to-edge repair on atrial fibrillation burden: Insights from a multicenter cohort.

BACKGROUND: Patients with significant mitralregurgitation (MR) often experience atrial fibrillation (AF). The effects of transcatheter edge-to-edge repair (TEER) for MR on AF burden is unknown. METHODS: Patients who underwent TEER atthree institutions who also had a cardiac implantable electronic device with aright atrial lead were retrospectively identified. In patients with baseline AF, device data onAF burden and echocardiographic changes were recorded at baseline and 3- and 12-month follow up time points when available. Data is expressed as number (%) and median (interquartile range), withpaired values analyzed using the Wilcoxon signed-rank test. RESULTS: Overall 66 patients wereidentified, of whom 54 (82%) had baseline data on AF available for review. Of these, 18 (33%) had a baseline burden ofAF (median burden 100% [54-100%]). Patients were 77 (71-83) years old, 10 (56%) male, 14 (78%) White, and 3 (17%) Black. A significant reduction in AF burdenwas observed at 3 months (11 patients, p = 0.03) which did not retainsignificance at 12 months (8 patients, p = 0.69). Indexed maximal left atrial volumes did not significantly change inthose with paired studies available (p > 0.35 for both time points). CONCLUSIONS: In this multicenter cohort, one thirdof patients with severe MR undergoing TEER had an AF burden at baseline, whichwas found to be significantly lower at 3 month follow up. Further investigation is needed to confirm thefindings of this small cohort and determine its effects on downstream sequelaeof AF.

The deterioration of driving performance over time in drivers with untreated sleep apnea.

Sleep apnea increases risk of driving crashes when left untreated. This study examined the driving performance decrements of untreated, undiagnosed sleep apnea drivers compared with healthy controls in a monotonous highway driving simulator task. It was hypothesized that the sleep apnea group would perform worse during a driving simulator test compared with the control group. A significant group by time interaction occurred indicating that sleep apnea participants' performance degraded more quickly over the course of the drive. In contrast with previous studies, this sleep apnea group did not include sleep disorder center patients, but rather community volunteers whose screening indicated a significant apnea/hypopnea index of 15 or greater. There may be inherent differences between patients and nonpatients with sleep apnea, as patients may have a more significant impact on their quality of life, causing them to seek treatment. Still, the results are clear that although the sleep apnea group drove similarly to the control group at the start of the drive, they are sensitive to time on task effects. These results support the need to diagnose and treat sleep apnea.