Unraveling right atrial plasticity after tricuspid edge-to-edge repair: structural, functional and rhythm-dependent remodeling in 3 phases

Abstract Background Right atrial (RA) remodeling after transcatheter tricuspid edge-to-edge repair (T-TEER) remains poorly characterized, particularly regarding the interplay between structural and functional changes and the role of cardiac rhythm. Objective To evaluate serial RA structural (volume) and functional (strain) remodeling after T-TEER, and to investigate the impact of cardiac rhythm on late functional recovery. Methods In 114 consecutive patients undergoing T-TEER, RA volume and longitudinal strain were assessed at baseline, pre-discharge, 6 months, and 12 months using 2D echocardiography and speckle-tracking. Procedural success was defined as residual tricuspid regurgitation ≤ moderate. Results RA remodeling followed a biphasic course. RA volume decreased significantly immediately post-procedure (−18.8%, p