Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Abstract

Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95–97.78) and 92.0% (95% CI: 85.26–95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan–Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

Association of longitudinal left atrial strain with mortality after tricuspid valve surgery

“…dyspnoea) are associated with adverse outcomes after TR surgery 13–15 . Additionally, AF‐associated TR resulted in reduced leaflet coaptation, which increases the recurrence risk of both AF and TR 16,17 . This study showed that higher mortality was associated with older age and refractory AF.…”

“…[13][14][15] Additionally, AF-associated TR resulted in reduced leaflet coaptation, which increases the recurrence risk of both AF and TR. 16,17 This study showed that higher mortality was associated with older age and refractory AF. Nevertheless, only 45% of all study participants underwent the Maze procedure.…”

Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients

“…Small studies have also demonstrated that betablockers including carvedilol and bisoprolol improve RV systolic function (49). Some evidence supports the benefit of sinus rhythm restoration on the reduction of TR severity (50,51). However, these studies have been performed in patients with concomitant MR and preserved ejection fraction, and whether the improvement is due to a direct impact on TR per se or to an improvement in MR and left heart characteristics is unknown.…”

Frequency of Atrial Fibrillation and its Complication

“…Tethering height was the only risk factor for recurrent AF. 28 In our study the risk factors for AF is clearly identified as all patients having Rheumatic Heart Disease (RHD) 90 out of 90 (100%), Chronic Obstructive Pulmonary Disorder (COPD) 60 out of 60 (100%), Thyroid Disorder 50 out of 50 (100%), Coronary Heart Disease (CHD) 20 out of 20 (100%), Lower Respiratory Tract Infection (LRTI) 20 out of 20 (100%), Lone Atrial Fibrillation (LAF) 10 out of 10 (100%) have affected from AF, whereas the incidence of AF is reported having History of Congestive Heart Failure (CHF) was 28 out 80 (35%).…”