Impact of Moderate or Severe Tricuspid Regurgitation on the Outcome of Pulmonary Vein Isolation in Patients with Atrial Fibrillation

Pulmonary vein isolation (PVI) is a key treatment for atrial fibrillation (AF), aiming to electrically isolate the pulmonary veins to prevent arrhythmic triggers. Despite its effectiveness, AF recurrence remains a significant clinical challenge. Tricuspid regurgitation (TR), which often coexists with AF, may affect PVI outcomes, though this relationship has not been extensively studied until now.

This study aims to evaluate the impact of moderate to severe TR on the one-year outcomes of patients with AF undergoing PVI. Specifically, we assess recurrence rates, procedure time, complications, and fluoroscopy time in these patients.

The study included 69 patients with moderate or severe TR and 69 matched control patients with mild or no TR who underwent de novo PVI for AF (paroxysmal or persistent) between 2019 and 2023 at our center. Patients were matched for age, BMI, sex, and presence of moderate or severe mitral regurgitation using propensity score matching. PVI was performed using either a high-power short-duration technique (50W/15s) or a very high-power short-duration technique (90W/4s).

The study groups were similar in terms of baseline characteristics and comorbidities. Patients with TR had a significantly larger right atrial (RA) area (TR group: 24.19 ± 6.43 cm² vs. control: 18.16 ± 4.34 cm², p < 0.01) (Table 1). Acute entry and exit block were achieved in all patients. Procedure time (TR group: 111.3 ± 35.44 minutes vs. control: 106.06 ± 34.85 minutes, p = 0.32) and fluoroscopy time (TR group: 12.65 ± 7.20 minutes vs. control: 12.11 ± 6.92 minutes, p = 0.66) did not differ significantly between groups. Minor complications were comparable (TR group: 1 vascular complication and 2 cases of pericarditis vs. control: 3 vascular complications), with no major complications in either group. The recurrence rate in the first year after the 90-day blanking period was significantly higher in the TR group (30.43%) compared to the control group (14.40%, p = 0.04), indicating a higher risk of AF recurrence associated with TR (Table 2).

Patients with moderate or severe tricuspid regurgitation have a significantly higher risk of AF recurrence within one year after undergoing pulmonary vein isolation. These findings highlight the importance of considering concomitant TR in patients with AF receiving PVI. Future studies should explore the mechanisms underlying this association and evaluate potential strategies to improve outcomes in these patients, which might extend beyond ablations in the left atrium.