Key result
Surgical ablation and tricuspid valve repair reduced the risk of atrial fibrillation recurrence (SHR 0.669) and stroke compared to catheter ablation, with the benefit primarily seen in patients with severe leaflet tethering (≥6 mm).
Why the study?
The study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation-caused tricuspid regurgitation.
Does catheter ablation compared to surgical ablation with tricuspid valve repair improve survival and reduce recurrence of atrial fibrillation and tricuspid regurgitation in patients with long-standing persistent atrial fibrillation and moderate-severe tricuspid regurgitation?
Cohort (n=393)
No
Does catheter ablation compared to surgical ablation with tricuspid valve repair improve survival and reduce recurrence of atrial fibrillation and tricuspid regurgitation in patients with long-standing persistent atrial fibrillation and moderate-severe tricuspid regurgitation?
In patients with moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation, catheter ablation is effective for those with tricuspid tethering height < 6 mm, whereas surgical ablation with valve repair yields better outcomes for those with severe tethering (≥ 6 mm).
Catheter ablation may suffice when tethering height <6 mm; leaves open optimal approach for greater tethering pending randomized trials.
BACKGROUND: This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. METHODS: A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. RESULTS: The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan-Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047-0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357-09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359-0.981; P = 0.042) in catheter group. CONCLUSIONS: Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2020) conducted a cohort in Moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation (n=393). Surgical ablation and tricuspid valve repair vs. Catheter ablation was evaluated on Atrial fibrillation recurrence (SHR 0.669, 95% CI 0.486-0.976, p=0.036). Surgical ablation and tricuspid valve repair reduced the risk of atrial fibrillation recurrence (SHR 0.669) and stroke compared to catheter ablation, with the benefit primarily seen in patients with severe leaflet tethering (≥6 mm).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: