Triple Percutaneous Therapy for Mitral Regurgitation and Atrial Fibrillation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe mitral regurgitation and atrial fibrillation (n=1). Intervention: Single-session pulsed-field AF ablation, mitral transcatheter edge-to-edge repair, and LAAC.

Q: What does this research mean for the field?

A single-session triple percutaneous procedure combining pulsed-field atrial fibrillation ablation, mitral transcatheter edge-to-edge repair, and left atrial appendage closure is feasible and safe in selected high-risk patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Valentina Frittitta; Rocco Arancio; Giorgio Sacchetta; Giombattista Barrano; Giovanni Milazzo; Silvia Motta; Claudia Artale; Marco Contarini

doi:10.1016/j.jaccas.2026.108055

June 1, 2026JACC Case ReportsOpen Access

Triple Percutaneous Therapy for Mitral Regurgitation and Atrial Fibrillation

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Key result

Single-session pulsed-field AF ablation, mitral TEER, and LAAC demonstrates feasibility without complications.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

The feasibility of combining mitral transcatheter edge-to-edge repair, left atrial appendage closure, and AF ablation in a single session was unknown.

Is a single-session procedure combining mitral transcatheter edge-to-edge repair, LAAC, and AF ablation feasible and safe in a patient with severe MR and AF?

Key Points

To evaluate the feasibility and safety of combining multiple interventions for mitral regurgitation and atrial fibrillation in a single session.
Performed percutaneous procedures including pulsed-field AF ablation, mitral edge-to-edge repair, and left atrial appendage closure in one session.
Implemented pulmonary vein isolation and implanted a MitraClip and Watchman device.
Follow-up assessments confirmed the outcomes post-procedure.
Marked reduction in mitral regurgitation confirmed post-procedure.
Achieved complete closure of the left atrial appendage.
Maintained sinus rhythm without complications during the follow-up.

Study Design

Type

Case Report (n=1)

Structured PICO

Is a single-session procedure combining mitral transcatheter edge-to-edge repair, LAAC, and AF ablation feasible and safe in a patient with severe MR and AF?

P

Population

A 78-year-old woman with dilated cardiomyopathy, severe functional mitral regurgitation, and high-burden paroxysmal atrial fibrillation.

I

Intervention

Single-session procedure including pulsed-field AF ablation, mitral transcatheter edge-to-edge repair (MitraClip), and left atrial appendage closure (Watchman).

O

Outcome

Procedural feasibility, safety, MR reduction, LAAC success, and maintenance of sinus rhythm.

A single-session procedure combining mitral transcatheter edge-to-edge repair, LAAC, and AF ablation is feasible and safe in selected high-risk patients.

Implication

Supports feasibility of combined mitral TEER, LAAC, and PVI in one session; leaves open need for prospective trials before wider adoption.

Abstract

BACKGROUND: Patients with severe mitral regurgitation (MR), atrial fibrillation (AF), and contraindications to long-term anticoagulation often require multiple interventions. The feasibility of combining mitral transcatheter edge-to-edge repair, left atrial appendage closure (LAAC), and AF ablation in a single session is unknown. CASE SUMMARY: A 78-year-old woman with dilated cardiomyopathy, severe functional MR, and high-burden paroxysmal AF underwent a single-session procedure including pulsed-field AF ablation, mitral transcatheter edge-to-edge repair, and LAAC. Pulmonary veins were isolated, a MitraClip was deployed at A2-P2 with marked MR reduction, and a Watchman device was successfully implanted. The patient remained hemodynamically stable without complications, and follow-up confirmed effective MR reduction, complete LAAC, and maintenance of sinus rhythm. DISCUSSION: This case demonstrates the feasibility and safety of a combined single-session approach in selected high-risk patients. TAKE-HOME MESSAGES: A one-stop procedure can simultaneously address valvular disease, rhythm control, and stroke prevention. Multidisciplinary planning and operator expertise are essential for procedural success.

Discussion

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Cite This Study

Frittitta et al. (2026) conducted a case report in Severe mitral regurgitation and atrial fibrillation (n=1). Single-session pulsed-field AF ablation, mitral transcatheter edge-to-edge repair, and LAAC was evaluated. A single-session procedure combining pulsed-field AF ablation, mitral transcatheter edge-to-edge repair, and LAAC was successfully performed in a 78-year-old woman without complications.

synapsesocial.com/papers/6a226cc6763171746d5486fe https://doi.org/10.1016/j.jaccas.2026.108055

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Triple Percutaneous Therapy for Mitral Regurgitation and Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Triple Percutaneous Therapy for Mitral Regurgitation and Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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