Improvement in mitral and tricuspid regurgitation in patients with atrial fibrillation after restoration of sinus rhythm - a prospective cohort study

Abstract Introduction Secondary or functional mitral and tricuspid regurgitation (MR and TR) are caused by changes in left atrial or ventricular geometry. Atrial fibrillation (AF) has been identified to cause both functional MR and TR, yet the arrhythmia may be both the consequence and the cause of the valvular disease. To exclude potentially reversible effects of AF on MR and TR, evaluation in sinus rhythm (SR) is believed to be necessary, although data on success rates of SR restoration and the rate, extend and time needed for MR and TR recovery is limited. This study presents the results of a prospective registry including patients with AF and newly diagnosed at least moderate secondary MR or TR undergoing cardioversion or AF ablation. Methods and Results Eighty patients (46% male, average age 73.7 (68.0-81.0) years) with persistent atrial fibrillation and newly diagnosed at least moderate MR or TR who underwent either cardioversion or catheter ablation were included (see Table 1). Clinical and echocardiographic follow up was performed after 3 and 12 months. After an average follow up of 11.6 ± 9 months 77.4% of the patients with baseline moderate or severe MR still in SR (31 of 59 patients, 52.5%) showed a reduction to mild MR, severe MR was found only in 6.5% as compared to 25.8% at baseline. In those with AF recurrence mild MR was found only in 37.5%, severe MR was found in 25%, rising from 12.5% at baseline (see figure 1 and 2). For patients with at least moderate TR at baseline 69.7% of those in SR (33 of 57 patients, 57.9%) showed only mild TR at FU, the proportion of patients with at least moderate TR was reduced from 100% to 30.3%. In those with AF recurrence 35.3% of patients had mild TR at follow up, the rate of patients with at least moderate TR was 100% at baseline and 64.7% at FU (see figure 3 and 4). Conclusion A high proportion of patients with moderate to severe MR and TR and AF showed a reduction of regurgitation severity after successful restoration of sinus rhythm. This emphasizes the importance of considering rhythm control as part of diagnosis and even treatment of secondary TR and MR.Table 1 Figure 1-4