Evidence of Atrial Functional Mitral Regurgitation due to Atrial Fibrillation: Reversal With Arrhythmia Control

Study Questions:

How often does functional mitral regurgitation (MR) improve after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

This was a retrospective study of 53 patients (mean age 62 years) with moderate (72%) or severe (28%) functional MR and normal left ventricular function, who underwent RFCA of AF (persistent in 62%). Fifty-three patients with mild or no MR were randomly selected to serve as a control group. An echocardiogram was performed at a mean of 9 months post-ablation in 32/53 patients.

Results:

The mean left atrial volume and mitral annular size were significantly larger in the MR group than in the control group. The independent predictors of MR were annular size, age, and persistent AF. Twenty-one of the 32 MR patients (66%) with a follow-up echocardiogram had no AF recurrences during follow-up. Left atrial volume and mitral annular size decreased to a greater extent in patients without recurrent AF than in the patients with recurrent AF. Only 24% of the patients without recurrent AF still had moderate to severe MR during follow-up, compared to 82% of the patients who did have recurrent AF.

Conclusions:

The authors concluded that MR in patients without structural abnormalities of the mitral leaflets often improves after elimination of AF.

Perspective:

The only echocardiographic predictor of MR was annular size, suggesting that MR during AF is mediated by dilatation of the mitral annulus. An important implication of this study is that catheter ablation of AF may be more appropriate than mitral valve repair and a maze or modified-maze procedure in patients with AF and severe MR who have structurally normal mitral valve leaflets.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Valvular Heart Disease, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Mitral Valve Insufficiency, Ventricular Function, Catheter Ablation, Echocardiography


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