What is the clinical evidence from this study?

Study design: Observational. Population: Patients with persistent atrial fibrillation and newly diagnosed at least moderate functional mitral or tricuspid regurgitation undergoing cardioversion or catheter ablation (n=80). Intervention: Rhythm control via cardioversion or catheter ablation vs. Recurrent atrial fibrillation. Primary outcome: Improvement in valvular regurgitation grade (≥1 grade reduction) from baseline to 12-month follow-up.

What question did this study set out to answer?

This study aims to evaluate the effects of restoring sinus rhythm on functional mitral and tricuspid regurgitation in patients with atrial fibrillation.

February 21, 2026Open Access

Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

Key Result

Restoring and maintaining sinus rhythm through cardioversion or catheter ablation improved moderate or worse mitral regurgitation to mild in 77% of patients at 12 months compared to 38% improvement with recurrent atrial fibrillation.

Key Points

This study aims to evaluate the effects of restoring sinus rhythm on functional mitral and tricuspid regurgitation in patients with atrial fibrillation.
Prospective registry study in patients with atrial fibrillation and moderate or worse functional MR/TR.
Participants underwent rhythm control through cardioversion or catheter ablation.
Follow-up assessments were performed at 3 and 12 months to evaluate mitral and tricuspid regurgitation severity.
56% of patients with moderate or worse MR improved to mild MR at 12 months.
Among patients maintaining sinus rhythm, 77% showed MR improvement compared to 38% with AF recurrence.
54% of patients with at least moderate TR improved to mild TR at 12 months, with 70% improvement in those maintaining sinus rhythm.

Study Design

Type

Observational

Multicenter

Structured PICO

Does rhythm control via cardioversion or ablation improve functional mitral and tricuspid regurgitation in patients with atrial fibrillation?

Population

80 patients with persistent atrial fibrillation (AF) or atrial flutter (AFL) and newly diagnosed at least moderate functional mitral regurgitation (MR), tricuspid regurgitation (TR), or both. Median age 73.7 years, 54% female, single-center (Germany). Excluded: papillary muscle rupture, valve prolapse, leaflet perforation, previous valve surgery, or percutaneous MR and TR intervention.

Intervention

Rhythm control via electrical cardioversion or catheter ablation (pulmonary vein isolation) to restore sinus rhythm.

Outcome

Any improvement in valvular regurgitation grade (≥ 1 grade reduction) from baseline to follow-up at 12 months.surrogate

Restoring and maintaining sinus rhythm in patients with atrial fibrillation significantly reduces the severity of functional mitral and tricuspid regurgitation and promotes favorable cardiac reverse remodeling.

Limitations

Observer bias cannot be completely excluded due to lack of core lab analysis.
No formal inter- or intra-observer reproducibility analysis performed.
Previous echocardiographic data unavailable, so longer-standing MR/TR cannot be excluded.
6.8% of MR and 12.2% of TR patients lost to follow-up.
No long-term AF monitoring to assess AF burden effects was performed.
Changes in heart failure medication, diuretic therapy, and blood pressure control during follow-up were not systematically recorded, allowing potential residual confounding.

Abstract

Abstract Background Functional mitral and tricuspid regurgitation (MR and TR) are caused by changes in atrial and/or ventricular geometry. Atrial fibrillation (AF) has been identified as a cause of functional MR and TR, but the arrhythmia may also occur as a consequence of the valvular dysfunction. Data on the success of restoring sinus rhythm (SR) and subsequent MR/TR improvement remain limited. This study reports findings from the prospective Berlin-FMTR registry, which included patients with AF and newly diagnosed moderate or worse functional MR or TR undergoing cardioversion or ablation. Methods and results Eighty patients (46% male, median age 73.7 years) with persistent AF and at least moderate MR or TR underwent rhythm control via cardioversion or catheter ablation. Follow-up assessments were conducted at 3 and 12 months. After a mean of 11.6 ± 9 months, 45 patients (56%) remained in SR. At 12 months, 56% of patients with baseline moderate or worse MR improved to mild MR. Among those in SR, this rose to 77% versus 38% with AF recurrence. Only patients in SR showed significant improvements in LVEF, left atrial size, and heart failure symptoms. Similarly, 54% of patients with at least moderate TR at baseline improved to mild TR at 12 months. Among those maintaining SR, 70% showed TR improvement, compared to 35% with recurrent AF. Right ventricular function (TAPSE, RV diameter/volume) improved only in those in SR. Conclusion Restoring and maintaining SR led to significant reductions in MR and TR severity and cardiac remodeling. These findings support rhythm control as a key therapeutic strategy in patients with AF and functional MR/TR. Graphical Abstract

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Discussion

Authors

Philipp Attanasio

Felix Schwarz

Fabian Barbieri

Journals

Clinical Research in Cardiology

Actions

Institutions

Charité - Universitätsmedizin Berlin

German Centre for Cardiovascular Research

Deutsches Herzzentrum der Charité

References and Citations

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Improvement of functional mitral and tricuspid regurgitation in patients with atrial fibrillation after sinus rhythm restoration—the Berlin FMTR registry

Key Result

Key Points

Study Design

Structured PICO

Limitations

Abstract

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Discussion

Authors

Journals

Actions

Institutions

References and Citations

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Discussion

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