Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation

Nishiwaki, Shushi; Watanabe, Sumio; Yoneda, Fumiya; Tanaka, Masaki; Aizawa, Takanori; Yamagami, Shintaro; Komasa, Akihiro; Kawaji, Tetsuma; Yoshizawa, Takashi; Kohjitani, Hirohiko; Morimoto, Takeshi; Kimura, Takeshi; Shizuta, Satoshi

doi:10.1007/s10840-022-01410-x

Cited by 8 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rhythm control strategy by cardioversion or catheter ablation may reduce the risk of incident significant A-STR and, once present, reduce its severity and slow its progression by preventing chamber remodelling. 82 Restoration of SR was associated with a significant decrease in TR at 12 months, especially in patients with active restoration by cardioversion or catheter ablation, who showed reverse remodelling of the LA, RA, and RV. 10 Sustained AF tripled the risk of clinically relevant TR compared with recurrent paroxysmal AF, 9 suggesting that AF burden and duration, as well as RA size, should be considered for decision-making.…”

Section: Treatment Of Atrial Secondary Tricuspid Regurgitationmentioning

confidence: 89%

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Muraru,

Badano,

Hahn

et al. 2024

European Heart Journal

View full text Add to dashboard Cite

Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%–15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.

show abstract

Section: Treatment Of Atrial Secondary Tricuspid Regurgitationmentioning

confidence: 89%

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Muraru,

Badano,

Hahn

et al. 2024

European Heart Journal

View full text Add to dashboard Cite

show abstract

“…TR severity and jet area, as well as mitral regurgitation jet area, are improved after catheter ablation in AF patients with significant TR after retrospectively analyzing consecutive 64 patients with functional TR in Nishiwaki S’s study [ 12 ]. Soulat-Dufour L et al reported shrinkage of right atrium volume after catheter ablation, thereafter, multiple studies observed consistent findings with shrinkage of tricuspid valve annulus post-ablation [ 13 , 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have proved that AF predisposes patients to TR progression [ 2 , 7 ]. The severity of TR and TR jet area were significantly improved during follow-up after radiofrequency ablation to restore sinus rhythm, and the improvement of TR may be related to the reverse remodeling of the right heart [ 12 – 17 ]. Although the worsening TR is associated with AF, there is limited research focused on the effect of restoring sinus rhythm on the TR severity.…”

Section: Introductionmentioning

confidence: 99%

Sinus rhythm restoration reverses tricuspid regurgitation in patients with atrial fibrillation: a systematic review and meta-analysis

Zhan,

2024

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Tricuspid regurgitation (TR) is a common valvular heart disease worldwide, and current guidelines for TR treatment are relatively conservative, as well as with detrimental outcomes. Restoration of sinus rhythm was reported to improve the TR severity in those TR patients with atrial fibrillation (AF). However, relevant research was limited. The aim of this meta-analysis was to evaluate the clinical outcomes of restoration of sinus rhythm in TR patients with AF. Methods In this study, PubMed, Web of Science, and Scopus databases were searched for study enrollment until July 2023. This study was designed under the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. These studies containing the patient’s baseline characteristics, surgical procedure, and at least one of the clinical outcomes were included. The primary endpoint was TR grade during follow-up after restoration of sinus rhythm. Results Out of 1074 records, 6 were enrolled. Restoration of sinus rhythm is associated with a reduction of TR severity (TR grade, odds ratio 0.11, 95% confidence interval (CI): 0.01 to 1.28, P = 0.08, I2 = 83%; TR area, mean difference (MD) -2.19 cm2, 95% CI: -4.17 to -0.21 cm2, P = 0.03, I2 = 96%). Additionally, remolding of right heart with a significant reduction of tricuspid valve annulus diameter (MD -0.36 cm, 95%CI: -0.47 to -0.26 cm, P < 0.00001, I2 = 29%) and right atrium volume index (MD -11.10 mL/m2, 95%CI: -16.81 to -5.39 mL/m2, P = 0.0001, I2 = 79%) was observed during follow-up. Conclusions In conclusion, rhythm-control therapy could reduce TR severity in AF patients with TR and is associated with right heart remodeling.

show abstract

“…Markman et al 4 analyzed the patients with at least moderate TR who underwent catheter ablation for AF, and reported that the degree of TR improved by at least one grade in more than 60% of the enrolled patients. Nishiwaki et al 10 have also investigated the impact of catheter ablation on functional TR in AF patients and concluded that TR severity and jet area improved after ablation in patients with AF and significant TR. Moreover, Soulat‐Dufour et al 11 investigated the functional regurgitation in patients with AF with/without sinus rhythm restoration (through cardioversion and/or ablation) at 12 months, and found a reduction in severity of tricuspid and mitral regurgitation after active restoration of SR.…”

Section: Discussionmentioning

confidence: 99%

Section: Absence Of Lr and Improvement Of Tr After Rfcamentioning

confidence: 99%

Predictors and outcomes of tricuspid regurgitation improvement after radiofrequency catheter ablation for persistent atrial fibrillation

Ukita

Egami

Nohara

et al. 2023

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). Methods We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow‐up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one‐grade improvement of TR) and non‐improvement of TR: IM group and Non‐IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all‐cause death) more than 12 months after the RFCA. Results IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event‐free survival than Non‐IM group. Conclusions Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes.

show abstract

Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation

Cited by 8 publications

References 24 publications

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Sinus rhythm restoration reverses tricuspid regurgitation in patients with atrial fibrillation: a systematic review and meta-analysis

Predictors and outcomes of tricuspid regurgitation improvement after radiofrequency catheter ablation for persistent atrial fibrillation

Contact Info

Product

Resources

About