Tricuspid regurgitation in atrial fibrillation: correlation to left atrial myopathy and improvement post ablation

Atrial fibrillation (AF) closely correlates to left atrial (LA) myopathy, which in turn can cause functional mitral regurgitation (FMR). The correlation of LA myopathy to tricuspid regurgitation (TR) is still unknown. Data on the dynamic change of TR post AF ablation is still limited.

We sought to investigate the correlation of LA myopathy to TR and furthermore if TR can be improved by AF ablation.

Consecutive patients presenting for first time AF ablation were prospectively enrolled. All patients underwent transthoracic echocardiography at baseline as well as 6 months after the ablation procedure. TR was graded as follows: minimal, mild, moderate and severe (I-IV). All study participants underwent high density bipolar voltagemaps prior to AF ablation to characterize the presence of atrial myopathy.

Our final study cohort consisted of 143 patients (age 64±11 years, 47% female, 48% persistent AF). 15% had no, 21% minimal, 35% mild, 19% moderate and 9% severe TR, respectively. High density maps with 1325±736 mapping points and with an average bipolar voltage of 1.58±0.89mV were created. A significant decline of average LA bipolar voltage was obvious, when comparing patients without TR to any severity level of TR (p=0.015) (Figure 1), however there was no significant difference in LA bipolar voltage, when comparing different TR severity levels (Figure 1). After a follow up of 6 months a significant improvement of TR was observed (p<0.001) with a median level of improvement by one level. 27% had no, 21% minimal, 31% mild, 18% moderate and 2% severe TR, respectively.

In patients presenting for AF ablation TR closely correlates with LA myopathy according to decreased levels of LA bipolar voltage. AF ablation results in highly significant TR level improvement.