Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation

Background: Tricuspid valve (TV) repair is the recommended treatment for severe functional tricuspid regurgitation (fTR) in patients undergoing left-sided surgery. For this purpose, a wide range of annuloplasty devices differing in form and flexibility are available. This study reports the results using a three-dimensional annuloplasty ring (Medtronic, Contour 3D Ring) for TV repair and analysis of risk factors. Methods: A cohort of 468 patients who underwent TV repair (TVr) with a concomitant cardiac procedure from December 2010 to January 2017 was retrospectively analyzed. Results: At follow-up, 96.1% of patients had no/trivial or mild TR. The 30-day mortality was 4.7%; it significantly differed between electively performed operations (2.7%) and urgent/emergent operations (11.7%). Risk factors for recurrent moderate and severe TR were LVEF < 50%, TAPSE < 16 mm, and moderate mitral valve (MV) regurgitation at follow-up. Preoperatively reduced renal function lead to a higher 30-day and overall mortality. Reoperation of the TV was required in six patients (1.6%). Risk factors for TV related reoperations were preoperative TV annulus over 50 mm and an implanted permanent pacemaker. Conclusions: TVr with the Contour 3D annuloplasty ring shows low TR recurrence and reoperation rates. Risk-factor analysis for the recurrence of TR revealed the importance of left- and right-ventricular function.

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THREE-DIMENSIONAL CARDIAC REMODELLING AFTER RESTORATION TO SINUS RHYTHM IN ATRIAL FIBRILLATION: ONE YEAR FOLLOW UP

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02772-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1414

Author(s):

Laurie Soulat-Dufour ◽

Sylvie Lang ◽

Karima Addetia ◽

Stephane Ederhy ◽

Saroumadi Adavane-Scheuble ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Three Dimensional ◽

Cardiac Remodelling ◽

One Year

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Abstract 15146: Reverse Right Heart Chambers Remodeling and Decrease in Tricuspid Regurgitation Severity After Restoration of Sinus Rhythm in Patients With Atrial Fibrillation: A Mid-term 3d Echocardiographic Study

Circulation ◽

10.1161/circ.142.suppl_3.15146 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Iris Benhamou Tarallo ◽

Laurie SOULAT-DUFOUR ◽

Sylvie Lang ◽

Stephane Ederhy ◽

Saroumadi Adavane-Scheuble ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Tricuspid Regurgitation ◽

Cardiac Rhythm ◽

Three Dimensional ◽

Integrated Approach ◽

Reverse Remodeling ◽

Right Heart ◽

The Right

Introduction: The natural history of tricuspid regurgitation (TR) and right heart chambers remodeling in patients with atrial fibrillation (AF) according to the cardiac rhythm at mid-term follow-up has been poorly assessed. Hypothesis: Restoration of sinus rhythm in AF patients is beneficial to the remodeling of right heart chambers and decrease in TR severity. Methods: We prospectively and serially evaluated 24 consecutive patients hospitalized for AF using three dimensional (3D) transthoracic echocardiography (TTE) at admission (M0) and every 6 months during a 2 years-follow-up (FU, M6, M12, M18, M24) (120 TTE exams). Patients were divided into two groups according to their cardiac rhythm at M24: restoration to SR (SR group, n=14) and persistence of AF (AF group, n=10). TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). 3D indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) as well as 3D tricuspid annulus (TA) area were analyzed in end systole (ES) and end diastole (ED). Results: Beyond 6 months of FU, the SR group had overall significantly lower 3D ES RA Vi, 3D ED RA Vi, 3D TA ES area and TR severity in comparison with AF group (Figure). There were no significant differences between the 2 groups with regard to 3D RV Volumes and 3D ED TA area. Conclusions: According to our results on both TR evolution and right heart cavities reverse remodeling, strategies aiming at SR restoration in patients with AF and TR should be broadly discussed.

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Faculty Opinions recommendation of Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718452511.793496331 ◽

2014 ◽

Author(s):

Michele De Bonis ◽

Maurizio Taramasso

Keyword(s):

Tricuspid Regurgitation ◽

Three Dimensional ◽

Tricuspid Annuloplasty ◽

Functional Tricuspid Regurgitation

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

European Heart Journal ◽

10.1093/eurheartj/ehab724.1701 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Nishiwaki ◽

S Watanabe ◽

F Yoneda ◽

M Tanaka ◽

A Komasa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Tricuspid Regurgitation ◽

Right Atrial ◽

Main Role ◽

Funding Sources ◽

Functional Tricuspid Regurgitation ◽

Significant Difference ◽

One Year ◽

The Impact

Abstract Background Since atrial functional tricuspid regurgitation (AF-TR) is associated with increased heart failure and mortality, the management of AF-TR is clinically important. Atrial fibrillation (AF) plays the main role in AF-TR. However, the effectiveness of catheter ablation (CA) and mechanism of improvement of AF-TR haven't been fully evaluated. Purpose We sought to investigate the impact of CA for AF on AF-TR in patients with moderate or more TR. Methods We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Japan. The current study population consisted of 102 patients with moderate or greater TR who underwent CA for AF. The echocardiographic parameters were compared between pre-ablation and post-ablation transthoracic echocardiography (TTE), and the recurrence rate of AF/ atrial tachycardia (AT) was measured. Results The mean age was 73.2 years, 53% were women. TR severity and TR jet area significantly improved after CA for AF (TR jet area: 5.8 [3.9–7.6] cm2 to 2.0 [1.1–3.0] cm2, p<0.001). In addition, mitral regurgitation (MR) jet area, left atrial (LA) area, mitral valve diameter, right ventricular (RV) end-diastolic area, right atrial (RA) area, tricuspid valve (TV) diameter decreased after CA (p<0.001, <0.001, <0.001, = 0.02, <0.001, and <0.001, respectively). There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE (moderate 28.6%, moderate to severe 37.2%, and severe 31.6%, p=0.72). Conclusions TR severity and jet area improved after CA in patients with AF and moderate or more TR. RV size, RA size, TV diameter also decreased after CA, which may be associated with TR improvement. There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE. FUNDunding Acknowledgement Type of funding sources: None.

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