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Valvular heart disease
Original research
Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation
  1. Myung-Jin Cha1,2,
  2. Seung-Ah Lee1,3,
  3. Min Soo Cho1,2,
  4. Gi-Byoung Nam1,2,
  5. Kee-Joon Choi1,2,
  6. Jun Kim1,2
  1. 1 Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
  2. 2 Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
  3. 3 Cardiac Imaging center, Heart institute, Asan Medical Center, Seoul, South Korea
  1. Correspondence to Dr Jun Kim, Department of Internal Medicine, University of Ulsan College of Medicine, Songpa-gu 05505, Korea; mdjunkim{at}gmail.com

Abstract

Objective Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity.

Methods A total of 106 patients with drug-refractory AF with moderate to severe secondary TR who underwent AF ablation were screened from a single-centre ablation registry. Echocardiographic parameter changes (pre-procedure vs 1 day/1 year post-procedure) were analysed. Holter monitoring was performed at 3/6/12 months to assess AF recurrence. The primary outcome was at least one grade TR reduction with its main determinants evaluated.

Results After excluding 36 patients (prior tricuspid valve surgery, intracardiac devices or insufficient data), 70 patients (aged 63.8±9.7 years, 50% female) were analysed. Of these, 17 (24.3%) had severe TR, 55 (78.6%) persistent AF and all restored sinus rhythm with catheter ablation. The primary outcome was achieved in 53 (75.7%) at 1-year assessment (73.6% of moderate and 82.4% of severe TR). There were significant decreases of vena contracta (6.1→3.2 mm) and tricuspid annular diameter (37.3→32.6 mm) at 1 year. Although 25 patients experienced AF recurrence within 1 year, 56 (80%) patients finally maintained sinus rhythm with medical treatment (87% in patients with TR reduction and 59% without). From the multivariate analysis, sinus rhythm maintenance was the most significant determinant of TR reduction (OR 8.3, 95% CI 1.8 to 37.4).

Conclusion In patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction.

  • atrial fibrillation
  • catheter ablation
  • tricuspid valve insufficiency

Data availability statement

No data are available. Our study data will not be made available to other researchers for purposes of reproducing the results because of institutional review board restrictions.

https://doi.org/10.1136/heartjnl-2023-323244

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    Data availability statement

    No data are available. Our study data will not be made available to other researchers for purposes of reproducing the results because of institutional review board restrictions.

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    Footnotes

    • M-JC and S-AL contributed equally.

    • Contributors The guarantors are JK and M-JC. The conception and design of the research were principally developed by JK. M-JC, a cardiac electrophysiologist, played a significant role in data interpretation and crafting the primary manuscript. As a first author, her expertise in electrophysiology was essential in outlining the study's scope and direction. S-AL, co-first author, is an imaging cardiologist who was pivotal in all echocardiographic measurements, reanalyses and reviews. She conducted the echocardiographic evaluations, ensuring the data's accuracy and relevance to the study's goals. The coauthors, MSC, G-BN and K-JC, contributed to the research's practical and scientific aspects. As electrophysiology physicians, they provided insights into the patient outcomes and study findings. They also actively engaged in the manuscript's revision and provided critical reviews, ensuring the study's comprehensive approach and high academic standard. Lastly, JK, the corresponding author and an electrophysiologist, was not only involved in the ideation but also played a supervisory role throughout the study. He collaborated with M-JC in the foundational stages of the research and oversaw its progression, ensuring consistency and integrity in all phases. All authors have read and approved the final version of the manuscript.

    • Funding This study was supported by a grant (2022IT0007-1) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.