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

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.