Key result
Post-ablation LA and MR reverse remodeling is linked to ~72% lower AF recurrence in AFMR.
Why the study?
Predictors of sinus rhythm maintenance after catheter ablation in patients with atrial functional mitral regurgitation are not well understood.
Does achieving both left atrial diameter reduction and mitral regurgitation improvement predict reduced atrial fibrillation recurrence in patients with significant atrial functional mitral regurgitation undergoing catheter ablation?
Cohort (n=56)
No
Does achieving both left atrial diameter reduction and mitral regurgitation improvement predict reduced atrial fibrillation recurrence in patients with significant atrial functional mitral regurgitation undergoing catheter ablation?
In patients with atrial fibrillation and significant functional mitral regurgitation, achieving both left atrial reverse remodeling and mitral regurgitation improvement after ablation is associated with a significantly lower risk of arrhythmia recurrence.
May identify lower AF recurrence risk post-ablation; hypothesis-generating and requires prospective validation before practice change.
Background: Atrial functional mitral regurgitation (FMR) results from left atrial enlargement and dysfunction, typically observed in patients with atrial fibrillation (AF). Predictors of sinus rhythm maintenance after catheter ablation in atrial FMR patients are not well understood. Methods and Results: We retrospectively reviewed 1,410 consecutive patients who underwent initial catheter ablation for AF at Kobe University Hospital between January 2014 and December 2022. Of these patients, 56 (4%; mean [±SD] age 68±8 years; 68% male) had significant (moderate, n=48; severe, n=8) atrial FMR based on pre-ablation transesophageal echocardiography. At follow-up echocardiography, a reduction in the left atrial diameter (LAd) was observed in 30 patients, whereas improvement in mitral regurgitation (MR) was noted in 26. During a mean follow-up period of 835 days, AF recurred in 23 (41%) patients. Kaplan-Meier curves for AF recurrence did not differ based on LAd reductions or MR improvements alone. However, recurrence rates were significantly lower in patients who achieved both LAd reduction and MR improvement than in those who did not achieve both changes (P=0.0259). Multivariate analysis revealed that the combination of LAd reduction and MR improvement was the only significant predictor of a decrease in AF recurrence (hazard ratio 0.275; 95% confidence interval 0.091-0.826; P=0.021). Conclusions: In AF patients with significant atrial FMR, achieving both LAd reduction and MR improvement after ablation is important to reduce the risk of AF recurrence.
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Shoda et al. (2025) conducted a cohort in Atrial fibrillation with significant atrial functional mitral regurgitation (n=56). Combination of left atrial diameter reduction (>5%) and mitral regurgitation improvement vs. Absence of combined left atrial diameter reduction and mitral regurgitation improvement was evaluated on Atrial fibrillation recurrence (HR 0.275, 95% CI 0.091-0.826, p=0.021). In patients with atrial fibrillation and significant atrial functional mitral regurgitation, achieving both left atrial diameter reduction and mitral regurgitation improvement after ablation significantly reduced the risk of AF recurrence (HR 0.275).
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