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Background <p>Atrial fibrillation (AF) is a&#xa0;common arrhythmia with significant health implications. Mitral regurgitation (MR) frequently coexists with AF and may affect treatment outcomes.</p> Methods <p>This study aimed to analyze the impact of MR severity on the outcomes of high-power short-duration pulmonary vein isolation (PVI) in patients with AF. This observational cohort study involved 255 patients undergoing their first PVI. A&#xa0;total of 83&#xa0;patients with moderate or severe MR were propensity score-matched with 83&#xa0;controls based on age, sex, and body mass index (BMI). Procedural parameters, complication rates, AF recurrence within 1&#xa0;year of PVI, and MR progression were analyzed.</p> Results <p>Patients with moderate or severe MR demonstrated a&#xa0;higher percentage of atrial low-voltage areas (23.06% vs. 15.42%, <i>p</i> = 0.04) and more frequently required additional ablations (18.07% vs. 6.02%, <i>p</i> = 0.02). The 1‑year AF recurrence rates were identical between the groups (19.28% each, <i>p</i> = 1.00). The MR grade remained stable without significant differences between the groups after 1&#xa0;year. However, among patients without AF recurrence, a&#xa0;statistically significant reduction in MR grade was observed after 1&#xa0;year (1.54 ± 0.64 vs. 1.37 ± 0.53, <i>p</i> &lt; 0.01). By contrast, patients with AF recurrence exhibited a&#xa0;trend toward worsening MR, although this change was not statistically significant (1.53 ± 0.57 vs. 1.75 ± 0.51, <i>p</i> = 0.09).</p> Conclusion <p>High-power short-duration PVI is safe and effective in AF patients, even among those with moderate or severe MR. Patients with moderate or severe functional MR exhibit more LA low-voltage areas and require more extensive ablations, especially cavotricuspid isthmus CTI ablation, reflecting a&#xa0;more complex disease profile. Maintaining a&#xa0;stable sinus rhythm can contribute to a&#xa0;reduction in MR grade.</p>

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Impact of functional mitral regurgitation on outcomes of high-power short-duration pulmonary vein isolation in patients with atrial fibrillation

  • 期刊论文

  • 发表日期：

    2025年5月23日

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  • A. Pinchuk,
  • V. Adam,
  • P. Biehler,
  • P. Hägele,
  • S. Hanger,
  • S. Löbig,
  • F. Ausbuettel,
  • C. Waechter,
  • P. Seizer,
  • S. Weyand

摘要

Background

Atrial fibrillation (AF) is a common arrhythmia with significant health implications. Mitral regurgitation (MR) frequently coexists with AF and may affect treatment outcomes.

Methods

This study aimed to analyze the impact of MR severity on the outcomes of high-power short-duration pulmonary vein isolation (PVI) in patients with AF. This observational cohort study involved 255 patients undergoing their first PVI. A total of 83 patients with moderate or severe MR were propensity score-matched with 83 controls based on age, sex, and body mass index (BMI). Procedural parameters, complication rates, AF recurrence within 1 year of PVI, and MR progression were analyzed.

Results

Patients with moderate or severe MR demonstrated a higher percentage of atrial low-voltage areas (23.06% vs. 15.42%, p = 0.04) and more frequently required additional ablations (18.07% vs. 6.02%, p = 0.02). The 1‑year AF recurrence rates were identical between the groups (19.28% each, p = 1.00). The MR grade remained stable without significant differences between the groups after 1 year. However, among patients without AF recurrence, a statistically significant reduction in MR grade was observed after 1 year (1.54 ± 0.64 vs. 1.37 ± 0.53, p < 0.01). By contrast, patients with AF recurrence exhibited a trend toward worsening MR, although this change was not statistically significant (1.53 ± 0.57 vs. 1.75 ± 0.51, p = 0.09).

Conclusion

High-power short-duration PVI is safe and effective in AF patients, even among those with moderate or severe MR. Patients with moderate or severe functional MR exhibit more LA low-voltage areas and require more extensive ablations, especially cavotricuspid isthmus CTI ablation, reflecting a more complex disease profile. Maintaining a stable sinus rhythm can contribute to a reduction in MR grade.