Does atrial fibrillation lead to tricuspid insufficiency

Gould, Lawrence; Weber, Donald J.; Schaffer, Abraham I.; O’Connor, Robert

doi:10.1016/0002-9149(65)90473-x

Cited by 13 publications

(6 citation statements)

References 13 publications

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“…Gould et al rst suggested that if AF increased the end-diastolic volume above a critical level, then it resulted in TR. 17 Isolated tricuspid annular dilatation that is related to RA enlargement might not be enough to cause severe functional TR in patients with AF, although most of the studies reported that tricuspid annular dilatation is related to RA volume. Further tricuspid annular dilatation with RV enlargement and remodeling might develop into severe TR, leading to an altered ventricular force balance to close the lea ets and incomplete closure of the TVs.…”

Section: Discussionmentioning

confidence: 99%

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis 

Wang

et al. 2020

Preprint

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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 < 6mm and ³ 6mm. Kaplan–Meier analysis showed in patients with tethering height < 6mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ³ 6mm, 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 6mm 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis 

Wang

et al. 2020

Preprint

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show abstract

“…The main findings showed that (i) catheter ablation without intervention for TV seemed to be an optional treatment in patients with less TV tethering, achieving satisfied SR restored rate and TR improvement; (ii) whereas patients with less leaflets coaptation might benefit more from surgical ablation and TV repair to achieve better SR restored rate and less TR deterioration than catheter ablation. Gould et al first suggested that if AF increased the end-diastolic volume above a critical level, then it resulted in TR [17]. Isolated tricuspid annular dilatation that is related to RA enlargement might not be enough to cause severe functional TR in patients with AF, although most of the studies reported that tricuspid annular dilatation is related to RA volume.…”

Section: Discussionmentioning

confidence: 99%

“…Gould et al first suggested that if AF increased the end-diastolic volume above a critical level, then it resulted in TR [ 17 ]. Isolated tricuspid annular dilatation that is related to RA enlargement might not be enough to cause severe functional TR in patients with AF, although most of the studies reported that tricuspid annular dilatation is related to RA volume.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2020

J Cardiothorac Surg

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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.

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“…Systolische Halsvenenpulsationen und systolische Leberpulsationen gelten als weitgehend spezifisch für eine TI; allerdings sind diese klinischen Zeichen nur in ausgeprägten Fällen nachweisbar (6,7,19,22,35,37).…”

Section: Introductionunclassified

“…Andererseits wird eine Abflachung bzw. ein Aufheben des x-Tals in der rechtsatrialen Druckkurve wie bei TI auch bei Rechtsherzinsuffizienz, Perikardkonstriktion und beim Vorhofflimmern beschrieben (5,19,73).…”

Section: Introductionunclassified

Die Radionuklidventrikulo- graphie - eine nichtinvasive Methode zur Diagnose und Quantifizierung der Trikuspidalklappeninsuffizienz

Waitzinger¹,

Seibold²,

Wieshammer³

et al. 1987

Nuklearmedizin

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The diagnosis of tricuspid regurgitation (TR) is difficult to make by simple clinical methods or by invasive techniques. Contrast echocardiography and Doppler echocardiography have improved diagnostic results, but a golden standard is still not available. Radionuclide ventriculography (RNV) is a well- established method for the detection and quantification of a volume load on the left ventricle: the regurgitation fraction can simply be derived from the regurgitant index as the ratio of enddiastolicendsystolic count-rate differences between the left and right ventricle. In left heart valvular regurgitation a regurgitant index exceeding the upper normal limit can be expected. This study was performed to evaluate the diagnostic accuracy of an abnormally low regurgitant index in detecting TR, which is accompanied by an isolated volume load on the right ventricle. A series of 33 patients with TR on physical examination and cardiac catheterization underwent RNV and was compared with 48 patients with right ventricular enlargement or pressure load on the right ventricle. In addition, the specificity of the method was evaluated in 470 consecutive patients with various forms of heart disease. In 18 out of 20 subjects with isolated TR a regurgitant index below the lower normal limit was found. The remaining 2 cases with minor TR had a regurgitant index within the normal range, which is 0.89 to 1.97 in this laboratory. In patients with additional volume load on the left ventricle, the sensitivity of the method was found to be low, as could be expected from the principle of the method. The time-activity curve over the liver was usually in phase with that recorded over the atria in subjects with TR. Therefore, the additional examination of a region of interest over the liver was particularly useful in these patients with concomitant aortic or mitral valve regurgitation. None of the 48 patients with right ventricular enlargement or pressure load on the right ventricle had a falsely positive result. A total of 17 out of 470 consecutive patients had a regurgitant index below the normal range; left ventricular function was severely impaired in 9 of these patients. The remaining subjects had a regurgitant index slightly below the lower normal limit. In conclusion, RNV has a high sensitivity in the diagnosis of TR in patients without left heart valvular regurgitation and a high specificity in patients without severely impaired left ventricular function and without left-to-right shunt through an atrial septal defect. As in patients with right ventricular volume load from an atrial septal defect, RNV appears to allow the quantification of TR. This, however, cannot be proven directly since a golden standard for quantification of TR is not available.

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Does atrial fibrillation lead to tricuspid insufficiency

Cited by 13 publications

References 13 publications

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis

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

Die Radionuklidventrikulo- graphie - eine nichtinvasive Methode zur Diagnose und Quantifizierung der Trikuspidalklappeninsuffizienz

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Does atrial fibrillation lead to tricuspid insufficiency

Cited by 13 publications

References 13 publications

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis&nbsp;

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis&nbsp;

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

Die Radionuklidventrikulo- graphie - eine nichtinvasive Methode zur Diagnose und Quantifizierung der Trikuspidalklappeninsuffizienz

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Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis

Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis