Atrial Fibrillation and Tricuspid Regurgitation in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair

BACKGROUND The interplay between atrial fibrillation (AF) and tricuspid regurgitation (TR) has been recognized. However, it is not simple and has not been fully investigated. OBJECTIVES The aim of this study was to examine the association among AF, TR, and outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER). METHODS Patients were divided into 4 groups according to the presence of AF and postprocedural significant TR (moderate or greater): no AF and no TR, no AF with significant TR, AF and no TR, and AF with significant TR. The primary outcome was cardiovascular death or heart failure (HF) hospitalization. Right heart structure and function were also evaluated according to AF and TR status. RESULTS The numbers of patients in each group were 1,184 (no AF and no TR), 229 (no AF with significant TR), 1,423 (AF and no TR), and 830 (AF with significant TR). AF was associated with a higher prevalence of significant TR at baseline and more frequent TR progression and less common improvement during follow-up. Both AF and TR appeared to be independently associated with right-ventricular remodeling and dysfunction, with distinct patterns observed according to MR and TR pathologies. TR grade moderate or greater after M-TEER was associated with a higher adjusted risk for cardiovascular death or HF hospitalization, especially in patients with AF (Pinteraction = 0.02). CONCLUSIONS Patients with AF, compared with those without AF, experienced greater incidence and progression and less common improvement of TR after M-TEER. In addition, both AF and TR appeared to be independently associated with worse right ventricular status and an increased risk for HF outcomes.