Beat-to-beat variability occurs not only in atrial fibrillation: clinical value of dynamic assessment of the mitral and tricuspid annulus

This editorial refers to ‘Atrial fibrillation is associated with large beat-to-beat variability in mitral and tricuspid annulus dimensions’ by J.A. Naser et al., pp.1362–73 ‘The snake which cannot cast its skin has to die. As well the minds which are prevented from changing their opinions; they cease to be mind’. ― Friedrich Nietzsche Both mitral and tricuspid annular (MA, TA) assessment have garnered significant interest in the imaging, structural, and surgical fields. Recent studies have suggested that, at least on the right side, annular diameter may be a better measure of tricuspid valve dysfunction than the severity of regurgitation, which is exquisitely sensitive to loading conditions. Outcome studies on transcatheter-tricuspid valve interventions suggest that valves with larger annular diameters are more likely to face procedural failure than those with smaller dimensions.1 TA sizing is important for choosing, guiding, and positioning devices such as the Trialign®,...