Impact of atrial fibrillation catheter ablation o’n tricuspid regurgitation severity: a systematic review and meta-analysis

Background Atrial fibrillation (AF) and tricuspid regurgitation (TR) commonly coexist and are associated with adverse clinical outcomes. Whether restoration of sinus rhythm through catheter ablation improves TR severity has not been systematically quantified. We evaluated the association between AF catheter ablation and changes in moderate or greater TR.Methods We performed a systematic review and meta-analysis of studies evaluating patients with AF undergoing catheter ablation and reporting paired preablation and postablation assessments of TR severity. MEDLINE, Embase, CENTRAL and Web of Science were searched from inception to 22 April 2026. The primary outcome was change in the prevalence of moderate or greater TR following ablation. Random-effects meta-analysis was performed using restricted maximum likelihood estimation. Meta-regression evaluated prespecified study-level modifiers, including sex proportion, mean age and baseline AF type.Results 17 studies comprising 2747 patients were included. AF catheter ablation was associated with a lower prevalence of moderate or greater TR (risk difference −0.21, 95% CI −0.33 to −0.09; pooled risk ratio 0.49, 95% CI 0.40 to 0.60), although heterogeneity was substantial (I²=98.3%) and the 95% prediction interval was wide (−0.74 to 0.31). Patients who maintained sinus rhythm had greater TR reduction than those with recurrent AF (risk difference −0.28, 95% CI −0.55 to −0.01). In meta-regression, higher proportions of female participants and persistent AF were associated with greater TR improvement, whereas mean left ventricular ejection fraction was not. Findings were consistent in sensitivity analyses restricted to studies at low-to-moderate risk of bias, observational studies and leave-one-out analyses.Conclusions AF catheter ablation was associated with a significant reduction in moderate or greater TR, with greater improvement among patients maintaining sinus rhythm. These findings support prospective evaluation of rhythm control as a potential strategy for patients with moderate or greater TR and AF.PROSPERO registration number CRD420251154277.