Feasibility and rationale of direct current cardioversion immediately after transcatheter percutaneous edge‐to‐edge mitral valve repair

Aims Atrial fibrillation (AF) is a frequent comorbidity among patients with severe mitral regurgitation (MR). Direct current (DC) cardioversion is one of the strategies for rhythm control. However, the safety and feasibility of immediate DC cardioversion after MitraClip are not elucidated. Methods and Results In this study, patients with symptomatic severe MR who underwent MitraClip were included. After fixing the MR, synchronized DC cardioversion was attempted for those with AF. A total of consecutive 60 patients, 36 subjects (60%), comorbid with AF. DC cardioversion was performed in 30 patients (mean age of 76.0 ± 9.3 years), and the successful conversion was achieved in 15 patients (50%). There was no any adverse event related to the cardioversion. Subjects with sustained conversion to SR experienced significant improvement in 6MWT (failed: 285 ± 110‐308 ± 135 m, P = .278; successful: 269 ± 109 m‐328 ± 78, P = .047) and reduction in NT‐proBNP level (failed: 4411 ± 7401‐3296 ± 4299 ng/mL, P = .217; successful: 4094 ± 2735‐2353 ± 2856 ng/mL, P = .026) at 1 month. Conclusions Direct current cardioversion seemed to be safe and feasible immediately after the transcatheter edge‐to‐edge mitral valve repairs. Subjects who maintain SR experienced better functional improvement.