Skip to main content
SpringerLink
Log in

Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated.

Methods

We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6–18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up.

Results

Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0–7.6] cm2 to 2.1 [1.1–3.1] cm2, P < 0.001). Moreover, mitral regurgitation jet area, left atrial area, mitral valve diameter, right ventricular end-diastolic area, right atrial area, and tricuspid valve diameter decreased at follow-up.

Conclusions

TR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83(6):897–902.

    Article  CAS  PubMed  Google Scholar 

  2. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43(3):405–9.

    Article  PubMed  Google Scholar 

  3. Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM, et al. Clinical outcome of isolated tricuspid regurgitation. JACC: Cardiovasc Imaging. 2014;7(12):1185–94.

    PubMed  Google Scholar 

  4. Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic types of tricuspid regurgitation: characteristics and prognostic implications. JACC Cardiovasc Imaging. 2019;12(3):491–9.

    Article  PubMed  Google Scholar 

  5. Silbiger JJ. Atrial functional tricuspid regurgitation: an underappreciated cause of secondary tricuspid regurgitation. Echocardiogr. 2019;36(5):954–7.

    Article  Google Scholar 

  6. Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel RJ, et al. Functional tricuspid regurgitation caused by chronic atrial fibrillation: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging. 2017;10(1).

  7. Abe Y, Akamatsu K, Ito K, Matsumura Y, Shimeno K, Naruko T, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J. 2018;82(5):1451–8.

    Article  PubMed  Google Scholar 

  8. Zack CJ, Fender EA, Chandrashekar P, Reddy YNV, Bennett CE, Stulak JM, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol. 2017;70(24):2953–60.

    Article  PubMed  Google Scholar 

  9. Axtell AL, Bhambhani V, Moonsamy P, Healy EW, Picard MH, Sundt TM 3rd, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74(6):715–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Taramasso M, Benfari G, van der Bijl P, Alessandrini H, Attinger-Toller A, Biasco L, et al. Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74(24):2998–3008.

    Article  CAS  PubMed  Google Scholar 

  11. Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart. 2018;104(10):798–806.

    Article  PubMed  Google Scholar 

  12. Markman TM, Plappert T, De Feria AA, Levin M, Amankwah N, Sheth S, et al. Improvement in tricuspid regurgitation following catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2020;31(11):2883–8.

    Article  PubMed  Google Scholar 

  13. Takahashi A, Iesaka Y, Takahashi Y, Takahashi R, Kobayashi K, Takagi K, et al. Electrical connections between pulmonary veins: implication for ostial ablation of pulmonary veins in patients with paroxysmal atrial fibrillation. Circulation. 2002;105(25):2998–3003.

    Article  PubMed  Google Scholar 

  14. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1–64.

    Article  PubMed  Google Scholar 

  15. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987;75(1):175–83.

    Article  CAS  PubMed  Google Scholar 

  16. Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984;107(3):526–31.

    Article  CAS  PubMed  Google Scholar 

  17. Miyatake K, Okamoto M, Kinoshita N, Ohta M, Kozuka T, Sakakibara H, et al. Evaluation of tricuspid regurgitation by pulsed Doppler and two-dimensional echocardiography. Circulation. 1982;66(4):777–84.

    Article  CAS  PubMed  Google Scholar 

  18. Itakura K, Hidaka T, Nakano Y, Utsunomiya H, Kinoshita M, Susawa H, et al. Successful catheter ablation of persistent atrial fibrillation is associated with improvement in functional tricuspid regurgitation and right heart reverse remodeling. Heart Vessels. 2020;35(6):842–51.

    Article  PubMed  Google Scholar 

  19. Topilsky Y, Maltais S, Medina Inojosa J, Oguz D, Michelena H, Maalouf J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019;12(3):433–42.

    Article  PubMed  Google Scholar 

  20. Akutsu Y, Kaneko K, Kodama Y, Suyama J, Li HL, Hamazaki Y, et al. Association between left and right atrial remodeling with atrial fibrillation recurrence after pulmonary vein catheter ablation in patients with paroxysmal atrial fibrillation: a pilot study. Circ Cardiovasc Imaging. 2011;4(5):524–31.

    Article  PubMed  Google Scholar 

  21. Wen S, Liu N, Bai R, Tang RB, Yu RH, Long DY, et al. Right atrial diameter and outcome of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2017;49(2):157–64.

    Article  PubMed  Google Scholar 

  22. Nishino S, Watanabe N, Ashikaga K, Morihisa K, Kuriyama N, Asada Y, et al. Reverse remodeling of the mitral valve complex after radiofrequency catheter ablation for atrial fibrillation: a serial 3-dimensional echocardiographic study. Circ Cardiovasc Imaging. 2019;12(10):e009317.

    Article  PubMed  Google Scholar 

  23. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.

    Article  PubMed  Google Scholar 

  24. Sugumar H, Prabhu S, Voskoboinik A, Young S, Gutman SJ, Wong GR, et al. Atrial remodeling following catheter ablation for atrial fibrillation-mediated cardiomyopathy: long-term follow-up of CAMERA-MRI study. JACC Clin Electrophysiol. 2019;5(6):681–8.

    Article  PubMed  Google Scholar 

  25. Therkelsen SK, Groenning BA, Svendsen JH, Jensen GB. Atrial and ventricular volume and function evaluated by magnetic resonance imaging in patients with persistent atrial fibrillation before and after cardioversion. Am J Cardiol. 2006;97(8):1213–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We appreciate the support and collaboration of the members of ultrasound center of Kyoto University Hospital.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan

    Shushi Nishiwaki, Shin Watanabe, Fumiya Yoneda, Munekazu Tanaka, Takanori Aizawa, Akihiro Komasa, Tetsuma Kawaji, Hirohiko Kohjitani, Takeshi Kimura & Satoshi Shizuta

  2. Department of Cardiology, Tenri Hospital, Tenri, Japan

    Shintaro Yamagami

  3. Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan

    Tetsuma Kawaji

  4. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Takashi Yoshizawa

  5. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan

    Takeshi Morimoto

Authors
  1. Shushi Nishiwaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shin Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumiya Yoneda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Munekazu Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takanori Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shintaro Yamagami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihiro Komasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tetsuma Kawaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takashi Yoshizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hirohiko Kohjitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takeshi Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takeshi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Satoshi Shizuta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin Watanabe.

Ethics declarations

Ethics approval

The ethics committee of Kyoto University Hospital approved the research protocol.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishiwaki, S., Watanabe, S., Yoneda, F. et al. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation. J Interv Card Electrophysiol 66, 1441–1453 (2023). https://doi.org/10.1007/s10840-022-01410-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-022-01410-x

Keywords

Search

Navigation