Key result
Pulmonary vein isolation after transcatheter tricuspid valve intervention was safe, but only 22% of patients remained free from atrial arrhythmia at a median 16 months follow-up.
Why the study?
AF often remains clinically significant after transcatheter tricuspid valve intervention for TR, but evidence regarding pulmonary vein isolation in this population is limited.
Does pulmonary vein isolation provide effective long-term rhythm control and safety in patients with atrial fibrillation after transcatheter tricuspid valve intervention?
Cohort (n=10)
No
Does pulmonary vein isolation provide effective long-term rhythm control and safety in patients with atrial fibrillation after transcatheter tricuspid valve intervention?
While pulmonary vein isolation is procedurally safe and feasible after transcatheter tricuspid valve intervention, long-term rhythm control is poor, likely due to irreversible atrial remodeling.
Background Atrial fibrillation (AF) is common in patients with heart failure with preserved ejection fraction (HFpEF) and contributes to right atrial and ventricular dilatation, functional tricuspid regurgitation (TR), and progressive right heart failure. Transcatheter tricuspid valve intervention (TTVI) effectively reduces TR; however, AF often remains clinically significant. Evidence regarding pulmonary vein isolation (PVI) in this population is limited. Purpose To evaluate the feasibility, safety, and rhythm outcomes of PVI in patients with AF after prior TTVI. Methods We retrospectively analyzed consecutive patients undergoing first-time PVI following TTVI between May 2021 and August 2025 at a single tertiary center. Procedural feasibility, acute success, complications, and maintenance of sinus rhythm (SR) during follow-up were assessed. Results Ten patients (mean age 76 ± 9 years; 8 [80%] female) were included. TTVI consisted of edge-to-edge repair in 6 patients, transcatheter annuloplasty in 2, and valve replacement in 1. Persistent AF was present in 8 patients (80%). Mean procedure duration was 88 ± 35 minutes. PVI was performed using thermal ablation (radiofrequency 6 [60%], cryoballoon 1 [10%]) or pulsed field ablation (3 [30%]). Additional substrate modification for low-voltage areas or atrial tachycardia was required in 3 patients (30%). Acute isolation of all pulmonary veins was achieved in all procedures. No major complications occurred. After a median follow-up of 16 months (IQR 14–22), 2 of 9 patients (22%) remained free from atrial arrhythmia. Conclusions PVI after TTVI is feasible and can be performed safely with contemporary ablation technologies. However, long-term rhythm control was poor, likely reflecting irreversible atrial remodeling. These findings highlight the need for individualized rhythm-control strategies in this challenging and increasingly prevalent patient population.
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Schipper et al. (2026) conducted a cohort in Atrial fibrillation after transcatheter tricuspid valve intervention (n=10). Pulmonary vein isolation was evaluated on Freedom from atrial arrhythmia. Pulmonary vein isolation after transcatheter tricuspid valve intervention was safe, but only 22% of patients remained free from atrial arrhythmia at a median 16 months follow-up.
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