Key result
Initial AF ablation linked to ~11-point lower 2-year mortality vs M-TEER in functional MR.
Why the study?
Atrial fibrillation (AF) and functional mitral regurgitation (FMR) frequently coexist, and while both catheter ablation and transcatheter edge-to-edge mitral valve repair (M-TEER) improve clinical status, the optimal sequence of these interventions as an initial strategy remains unclear.
Does initial catheter ablation compared to transcatheter edge-to-edge mitral valve repair improve survival, hospitalization rates, symptom stability, and mitral regurgitation severity in patients with atrial fibrillation and functional mitral regurgitation?
Observational (n=281)
No
Does initial catheter ablation compared to transcatheter edge-to-edge mitral valve repair improve survival, hospitalization rates, symptom stability, and mitral regurgitation severity in patients with atrial fibrillation and functional mitral regurgitation?
In patients with coexisting atrial fibrillation and functional mitral regurgitation, an initial strategy of catheter ablation was associated with lower all-cause mortality, fewer hospitalizations, better symptom stability, and higher follow-up LVEF compared to M-TEER, despite M-TEER achieving more frequent reductions in MR severity.
Should not yet change practice favoring ablation; leaves open need for randomized trials to confirm mortality benefit.
Background and Aim 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. 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, mortality, and hospitalization. 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 mitral regurgitation severity, symptom stability, mortality, and hospitalization. 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 = 0.021), and significant improvment in left ventricular ejection fraction at follow-up (53 ± 11.1%vs. 47 ± 13.9%, p < 0.001). Conclusion In functional MR, M-TEER reduced regurgitation degree more effectively, whereas AF ablation was associated with better survival, fewer hospitalizations, improved ventricular function, and greater symptom stability, supporting rhythm control as a preferred initial strategy in selected AF-related functional MR patientsKaplan–Meier of all-cause mortalityKaplan–Meier of time to first hospitalisation
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El-Shirbiny et al. (2026) conducted an observational in Atrial fibrillation with functional mitral regurgitation (n=281). Catheter ablation for atrial fibrillation vs. Transcatheter edge-to-edge mitral valve repair (M-TEER) was evaluated on All-cause mortality (p=0.002). Initial AF ablation vs M-TEER in AF with functional MR was associated with lower all-cause mortality (3% vs 14%, p=0.002) and greater symptom stability (69% vs 44%, p<0.001) at 2 years.
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