Background:
Functional mitral regurgitation (MR) frequently accompanies atrial fibrillation (AF) and may improve following restoration of sinus rhythm. However, data on patient-reported satisfaction after catheter ablation in this subgroup are limited. This study aimed to evaluate echocardiographic outcomes and patient satisfaction twelve months after pulmonary vein isolation (PVI).
Methods:
In this prospective observational study, 250 patients with AF and at least moderate MR underwent PVI between 2020 and 2023. Of these, 222 patients (88.8%) completed 12-month follow-up and were included in the final analysis. Echocardiographic parameters (MR severity, left ventricular ejection fraction (LVEF), left atrial (LA) size) and rhythm status were assessed at baseline and follow-up. Patient satisfaction was measured using the validated Freiburg Index of Patient Satisfaction (FIPS), ranging from 1 (very satisfied) to 6 (very dissatisfied). Paired t-tests and multivariate linear regression analyses were performed to identify predictors of change in satisfaction (ΔFIPS).
Results
After 12 months, mean LVEF increased significantly from 55.6 ± 8.8% at baseline to 56.9 ± 7.5% at follow-up (p < 0.01). LA diameter decreased from 42.4 ± 7.8 mm to 40.1 ± 7.9 mm (p < 0.01), while LA area remained stable (25.4 ± 5.1 cm² vs. 25.4 ± 5.5 cm², p = 0.67). Vena contracta width declined from 6.1 ± 1.5 mm to 5.5 ± 2.0 mm (p < 0.01), and the proportion of patients with moderate or severe MR decreased from 100% to 83.8% (p < 0.01). Among patients maintaining sinus rhythm, MR severity and LA diameter improved more markedly than in those with AF recurrence (Δvena contracta − 0.88 ± 1.6 mm vs. +0.58 ± 2.2 mm, p < 0.01; ΔLA diameter − 2.9 ± 4.2 mm vs. − 0.1 ± 2.9 mm, p < 0.01). No significant difference was observed in LVEF change between groups (+1.6 ± 6.9% vs. +1.7 ± 6.0%, p= 0.80). Patient-reported satisfaction improved substantially, with mean FIPS scores decreasing from 2.26 ± 0.68 to 1.89 ± 0.70 (p < 0.01). Patients in stable sinus rhythm demonstrated a greater improvement in satisfaction (ΔFIPS − 0.43 ± 0.56 vs. − 0.11 ± 0.58, p < 0.01). No major procedural or follow-up complications occurred.
Conclusion:
In patients with atrial fibrillation and moderate-to-severe mitral regurgitation, pulmonary vein isolation led to significant improvements in echocardiographic parameters and patient satisfaction after one year. Restoration and maintenance of sinus rhythm were associated with reduced MR severity and reverse atrial remodeling, underscoring the importance of effective rhythm control in this population.
