Sinus rhythm patients showed significant TR improvement and reduced RAVI at 12 months post-ASD closure, unlike post-ablation or permanent AF groups with persistent TR.
Does baseline cardiac rhythm affect the improvement of functional tricuspid regurgitation following transcatheter atrial septal defect closure in adult patients?
Patients with a history of atrial fibrillation, even if in sinus rhythm post-ablation, may not experience improvement in functional tricuspid regurgitation after transcatheter ASD closure, highlighting the need for careful monitoring and potentially earlier intervention.
Absolute Event Rate: 0% vs 0%
Abstract Aims The changes in tricuspid regurgitation (TR) following transcatheter atrial septal defect (ASD) closure, in relation to pre-procedural cardiac rhythms, remain unknown. This study aimed to assess the sequential changes in TR after ASD closure based on cardiac rhythms. Methods and results Patients were categorized based on baseline cardiac rhythms: sinus rhythm (SR group, n=89), SR after catheter ablation for atrial fibrillation (ABL group, n=14), and permanent atrial fibrillation (AF group, n=12). Echocardiography was performed at baseline, 1 day, 1 month, and 12 months after the procedure. There were significant differences in age (54.5 ± 17.5 years vs. 63.9 ± 12.6 years vs. 74.3 ± 8.4 years; p 0.01) and prevalence of moderate TR at baseline (44.9% vs. 78.6% vs. 91.7%; p 0.01) in the SR, ABL, and AF groups, respectively. The SR group showed significant improvement in TR as early as 1-day post-closure, which persisted at 12 months, whereas the ABL and AF groups exhibited no significant improvements in TR from baseline through 1 day, 1 month, and 12 months post-procedure (Figure 1). The changes in right ventricular annular diameter (RAVI) across different cardiac rhythm groups are illustrated in Figure 2(A). In the SR group, there was a significant gradual decrease in the RAVI from baseline through 1 day, 1 month, and 12 months post-ASD closure. In contrast, the ABL and AF group demonstrated a non-significant trend for decreasing RAVI over the same time points. At 12 months post-ASD closure, the RAVI was significantly lower in the SR group (28.8 19.9 – 35.0 mL/m²) compared to both the ABL group (43.1 25.0 – 46.2 mL/m², p=0.01) and the AF group (63.3 39.9 – 90.7 mL/m², p0.01). The changes in tricuspid annular diameter according to cardiac rhythm groups are depicted in Figure 2(B). The tricuspid annular diameter significantly decreased over time from baseline to 1 day, 1 month, and 12 months post-procedure in the SR group. In contrast, there was no significant reduction in the ABL and AF groups during the follow-up period. Independent predictors of residual moderate TR at 12 months included being in the ABL or AF groups and having a higher right atrial volume index at baseline. Conclusion Persistent TR may remain after ASD closure, even for patients who achieve SR post-ablation and those with permanent AF. These findings highlight the importance of timely therapeutic interventions and careful monitoring for residual TR following ASD closure, especially in patients with a history of AF.ASD figure1 ASD figure2
Noda et al. (Sat,) reported a other. Sinus rhythm patients showed significant TR improvement and reduced RAVI at 12 months post-ASD closure, unlike post-ablation or permanent AF groups with persistent TR.