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. 2025 Jun;12(3):1905-1915.
doi: 10.1002/ehf2.15197. Epub 2025 Mar 26.

Severity of tricuspid regurgitation predicts risk of recurrence of atrial fibrillation after pulmonary vein isolation

Jan Wintrich  1   2 , Dimitrios Bismpos  1   2 , Anika Teusch  1 , Valerie Pavlicek  1 , Patrick Fischer  1 , Felix Mahfoud  1   3   4 , Michael Böhm  1 , Christian Ukena  1   2
Affiliations

Severity of tricuspid regurgitation predicts risk of recurrence of atrial fibrillation after pulmonary vein isolation

Jan Wintrich et al. ESC Heart Fail. 2025 Jun.

Abstract

Aims: Tricuspid regurgitation (TR) results in right atrial remodelling, thus promoting the formation of a substrate for atrial fibrillation (AF). In turn, AF may cause TR by annulus dilatation. We investigated whether the presence of TR affects the efficacy of pulmonary vein isolation (PVI) for AF.

Methods and results: In patients undergoing PVI, we compared the severity of TR before and 6 months after the procedure. Moderate to severe TR was defined as advanced. Moreover, we investigated whether the severity of TR, at baseline and 6 months after PVI, predicted the recurrence of AF. Out of 320 patients, advanced TR at baseline was documented in 13.1%. Six months after PVI, the proportion of patients with advanced TR (13.1% to 7.2%; P < 0.001) decreased significantly. Compared with patients with post-interventional improvement of advanced TR, right atrial (RA) dilatation at baseline was more pronounced in patients without TR improvement (RA area 20.2 ± 4.4 vs. 26.6 ± 8.3 cm). The presence of advanced TR, particularly without improvement during the follow-up, increased the risk of AF recurrences compared with patients without advanced TR. Even after propensity-score matching, TR at baseline remained an independent risk predictor regarding recurrent AF [hazard ratio 2.2 (95% confidence interval, 1.1-4.9); P = 0.045]. Advanced MR was not associated with increased risk of AF.

Conclusions: In AF patients undergoing PVI, the presence of advanced TR, particularly without improvement 6 months after the procedure, was associated with an increased risk of AF recurrences.

Keywords: atrial fibrillation; catheter ablation; mitral regurgitation; right ventricular function; tricuspid regurgitation.

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Conflict of interest statement

V. P. has received honoraria from Bayer. M. B. has received lecture honoraria and consulting fees from Amgen, Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Medtronic, Novartis, Servier and Vifor. F. M. is supported by the Deutsche Gesellschaft für Kardiologie (DGK), Deutsche Forschungsgemeinschaft (SFB TRR219, Project‐ID 322900939) and Deutsche Herzstiftung. He has received scientific support from Ablative Solutions, Medtronic and ReCor Medical and speaker honoraria/consulting fees from Ablative Solutions, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor Medical, Servier and Terumo. J. W. has received lecture honoraria from Bristol Myers Squibb. C. U. has received lecture honoraria from Bayer, Bristol Myers Squibb, Medtronic and ReCor Medical.

Figures

Figure 1
Figure 1
Study design and population.
Figure 2
Figure 2
(A,B) Change in the degree of tricuspid regurgitation after pulmonary vein isolation. TR, tricuspid regurgitation.
Figure 3
Figure 3
Time to atrial fibrillation recurrence depending on the presence of advanced TR at baseline (A), and at 6 months follow‐up (B). CI, confidence interval; HR, hazard ratio; PVI, pulmonary vein isolation; TR, tricuspid regurgitation.
Figure 4
Figure 4
Time to atrial fibrillation recurrence depending on the post‐ablation change in tricuspid regurgitation severity. PVI, pulmonary vein isolation; TR, tricuspid regurgitation.
Figure 5
Figure 5
Time to atrial fibrillation recurrence depending on the degree of pre‐interventional tricuspid regurgitation after propensity‐score matching. CI, confidence interval; HR, hazard ratio; PVI, pulmonary vein isolation; TR, tricuspid regurgitation.
See this image and copyright information in PMC

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