Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

Q: What are the key findings of this study?

Restoring and maintaining sinus rhythm through cardioversion or catheter ablation improved moderate or worse mitral regurgitation to mild in 77% of patients at 12 months compared to 38% improvement with recurrent atrial fibrillation.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients with persistent atrial fibrillation and newly diagnosed at least moderate functional mitral or tricuspid regurgitation undergoing cardioversion or catheter ablation (n=80). Intervention: Rhythm control via cardioversion or catheter ablation vs. Recurrent atrial fibrillation. Primary outcome: Improvement in valvular regurgitation grade (≥1 grade reduction) from baseline to 12-month follow-up.

Q: What does this research mean for the field?

Restoring and maintaining sinus rhythm through cardioversion or catheter ablation improves moderate or worse functional mitral regurgitation to mild in 77% of patients at 12 months, compared to 38% in those with recurrent atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Philipp Attanasio; Felix Schwarz; Fabian Barbieri; Anna Sannino; Mario Kašner; Markus Reinthaler; Ulf Landmesser; Gerhard Hindricks; Martin Huemer

doi:10.1007/s00392-026-02877-8

February 19, 2026Clinical Research in CardiologyOpen Access

Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

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Key result

Maintaining sinus rhythm is linked to MR improvement in ~77% of patients versus recurrent AF.

n=80

Why the study?

AF causes functional MR and TR or can occur as a consequence of valvular dysfunction, but data on the success of restoring SR and subsequent MR/TR improvement remain limited.

Does rhythm control via cardioversion or ablation improve functional mitral and tricuspid regurgitation in patients with atrial fibrillation?

Key Points

To assess the effect of restoring and maintaining sinus rhythm via cardioversion or catheter ablation on functional mitral and tricuspid regurgitation in patients with atrial fibrillation.
Prospective registry study of 80 patients (46% male, median age 73.7 years) with persistent AF and at least moderate functional MR or TR undergoing rhythm control via cardioversion (44%) or catheter ablation (56%).
Patients underwent clinical and echocardiographic evaluations at baseline, 3 months, and 12 months (mean follow-up of 11.6 ± 9 months).
At 12 months, 56% of patients with baseline moderate or worse MR improved to mild MR, rising to 77% in those maintaining sinus rhythm versus 38% in those with AF recurrence.
At 12 months, 54% of patients with baseline moderate or worse TR improved to mild TR, reaching 70% in patients maintaining sinus rhythm compared to 35% with AF recurrence.
Patients maintaining sinus rhythm experienced significant improvements in LVEF (42 ± 13% to 51 ± 11%, p < 0.001 vs. p = 0.025 between groups), left atrial diameter and volume, TAPSE, and heart failure symptoms.

Study Design

Type

Observational (n=80)

Multicenter

No

Structured PICO

Does rhythm control via cardioversion or ablation improve functional mitral and tricuspid regurgitation in patients with atrial fibrillation?

P

Population

80 patients with persistent atrial fibrillation (AF) or atrial flutter (AFL) and newly diagnosed at least moderate functional mitral regurgitation (MR), tricuspid regurgitation (TR), or both. Median age 73.7 years, 54% female, single-center (Germany). Excluded: papillary muscle rupture, valve prolapse, leaflet perforation, previous valve surgery, or percutaneous MR and TR intervention.

I

Intervention

Rhythm control via electrical cardioversion or catheter ablation (pulmonary vein isolation) to restore sinus rhythm.

O

Outcome

Any improvement in valvular regurgitation grade (≥ 1 grade reduction) from baseline to follow-up at 12 months.surrogate

Main Result

Absolute Event Rate: 77% vs 38%

Restoring and maintaining sinus rhythm in patients with atrial fibrillation significantly reduces the severity of functional mitral and tricuspid regurgitation and promotes favorable cardiac reverse remodeling.

Limitations

Observer bias cannot be completely excluded due to lack of core lab analysis.
No formal inter- or intra-observer reproducibility analysis performed.
Previous echocardiographic data unavailable, so longer-standing MR/TR cannot be excluded.
6.8% of MR and 12.2% of TR patients lost to follow-up.
No long-term AF monitoring to assess AF burden effects was performed.
Changes in heart failure medication, diuretic therapy, and blood pressure control during follow-up were not systematically recorded, allowing potential residual confounding.
No core lab analysis of echo data was performed, observer bias cannot be completely excluded
No formal inter- or intra-observer reproducibility analysis was performed
Previous echocardiographic examinations were not available in most patients, longer-standing MR/TR cannot be excluded
6.8% in MR patients and 12.2% of TR patients were lost to follow-up
No long-term monitoring of AF using internal loop recorders was performed, AF burden effects on MR/TR reduction cannot be drawn
Changes in heart failure medication, diuretic therapy, and blood pressure control during follow-up were not systematically recorded

Implication

Rhythm control may reduce functional MR in AF; hypothesis-generating and requires RCTs before practice change.

Abstract

Background Functional mitral and tricuspid regurgitation (MR and TR) are caused by changes in atrial and/or ventricular geometry. Atrial fibrillation (AF) has been identified as a cause of functional MR and TR, but the arrhythmia may also occur as a consequence of the valvular dysfunction. Data on the success of restoring sinus rhythm (SR) and subsequent MR/TR improvement remain limited. This study reports findings from the prospective Berlin-FMTR registry, which included patients with AF and newly diagnosed moderate or worse functional MR or TR undergoing cardioversion or ablation. Methods and results Eighty patients (46% male, median age 73.7 years) with persistent AF and at least moderate MR or TR underwent rhythm control via cardioversion or catheter ablation. Follow-up assessments were conducted at 3 and 12 months. After a mean of 11.6 ± 9 months, 45 patients (56%) remained in SR. At 12 months, 56% of patients with baseline moderate or worse MR improved to mild MR. Among those in SR, this rose to 77% versus 38% with AF recurrence. Only patients in SR showed significant improvements in LVEF, left atrial size, and heart failure symptoms. Similarly, 54% of patients with at least moderate TR at baseline improved to mild TR at 12 months. Among those maintaining SR, 70% showed TR improvement, compared to 35% with recurrent AF. Right ventricular function (TAPSE, RV diameter/volume) improved only in those in SR. Conclusion Restoring and maintaining SR led to significant reductions in MR and TR severity and cardiac remodeling. These findings support rhythm control as a key therapeutic strategy in patients with AF and functional MR/TR.

Discussion

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Cite This Study

Attanasio et al. (2026) conducted an observational in Patients with persistent atrial fibrillation and newly diagnosed at least moderate functional mitral or tricuspid regurgitation undergoing cardioversion or catheter ablation (n=80). Rhythm control via cardioversion or catheter ablation vs. Recurrent atrial fibrillation was evaluated on Improvement in valvular regurgitation grade (≥1 grade reduction) from baseline to 12-month follow-up. Restoring and maintaining sinus rhythm through cardioversion or catheter ablation improved moderate or worse mitral regurgitation to mild in 77% of patients at 12 months compared to 38% improvement with recurrent atrial fibrillation.

synapsesocial.com/papers/69994c27873532290d02068a https://doi.org/10.1007/s00392-026-02877-8

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Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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