Key result
Initial catheter ablation is linked to ~79% lower mortality than M-TEER.
Why the study?
AF and FMR frequently coexist, and while both catheter ablation and M-TEER improve clinical status, the optimal sequence of these interventions remains unclear.
Does catheter ablation compared to M-TEER as an initial strategy improve clinical outcomes in patients with atrial fibrillation and functional mitral regurgitation?
Cohort (n=281)
No
Does catheter ablation compared to M-TEER as an initial strategy improve clinical outcomes in patients with atrial fibrillation and functional mitral regurgitation?
Absolute Event Rate: 3% vs 14%
p-value: p=0.002
In patients with coexisting AF and functional mitral regurgitation, an initial strategy of AF ablation is associated with lower mortality and hospitalizations compared to M-TEER, though this likely reflects baseline differences in disease stage.
Supports considering ablation first in AF-FMR; leaves open optimal sequencing versus M-TEER pending randomized trials.
BACKGROUND: Atrial fibrillation (AF) and functional mitral regurgitation (FMR) frequently coexist and are linked through shared mechanisms of atrial and ventricular remodeling. Both catheter ablation and transcatheter edge-to-edge mitral valve repair (M-TEER) improve clinical status, yet the optimal sequence of these interventions remains unclear. OBJECTIVE: This study evaluates real-world outcomes in patients with AF and FMR, comparing catheter ablation and M-TEER as initial strategies, with focus on MR severity, symptom stability, all-cause mortality, and all-cause cardiac hospitalizations. METHODS: We conducted a single-center retrospective analysis of patients with AF and moderate to moderate-to-severe FMR. Patients were grouped according to the initial treatment strategy: AF ablation or M-TEER. Clinical and echocardiographic data were reviewed at baseline and follow-up. A retrospective two-year follow-up was performed to evaluate changes in MR severity, symptom stability, all-cause mortality, and all-cause cardiac hospitalizations RESULTS: A total of 281 patients were included (129 M-TEER, 152 AF ablation). MR severity improved more frequently following M-TEER (p < 0.001). However, AF ablation was associated with better symptom stability (69% vs. 44%, p < 0.001), markedly lower all-cause mortality (3% vs. 14%, p= 0.002), less all-cause cardiac hospitalizations (p = 0. 0.019), and significant improvment in left ventricular ejection fraction at follow-up (53 ± 11.1%vs. 47 ± 13.9%, p < 0.001). CONCLUSION: M-TEER was associated with greater MR reduction, while AF ablation was associated with more favorable clinical outcomes. These findings likely reflect stage-dependent management rather than treatment superiority and require confirmation in prospective studies.
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El-Shirbiny et al. (2026) conducted a cohort in Atrial fibrillation and functional mitral regurgitation (n=281). Catheter ablation vs. Transcatheter edge-to-edge mitral valve repair (M-TEER) was evaluated on All-cause mortality (p=0.002). Initial catheter ablation was associated with lower all-cause mortality (3% vs. 14%, p=0.002) and better symptom stability (69% vs. 44%) than M-TEER, despite greater MR reduction with M-TEER.
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