Functional mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality and over the past decade, the diagnosis of atrial functional mitral regurgitation (aFMR) has been increasingly observed in the elderly, especially in those with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering distinguish the pathophysiology of aFMR from the one of ventricular origin. However, no consensus provides recommendations regarding the differential diagnosis and the subsequent management of aFMR. The advent of transcatheter mitral valve repair has paved the way for various treatments including edge-to-edge repair (TEER), mitral annuloplasty, and replacement, with optimistic results on short-medium-term outcome provided by preliminary studies. In parallel, rhythm control of AF for paroxysmal and persistent types, should be pursued to induce reverse remodeling and restoring the normal leaflet coaptation. In this setting, catheter ablation aiming for electrical isolation of the pulmonary veins is the most widely recognized and effective strategy for maintaining sinus rhythm. Nevertheless, arrhythmia-free survival is lower in patients with persistent and long-term persistent AF, leading to the adoption of hybrid strategies combining transcatheter endocardial ablation and thoracoscopic epicardial surgical ablation. This review provides an update on the diagnosis and treatment of aFMR, focusing on available transcatheter approaches that can be performed in the catheterization lab and electrophysiology lab.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The authors have nothing to report.

References

1E. J. Benjamin, P. Muntner, A. Alonso, et al., “Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association,” Circulation 139 (2019): e56–e528, https://doi.org/10.1161/cir.0000000000000659.
10.1161/CIR.0000000000000659
PubMed Web of Science® Google Scholar
2E. Anter, M. Jessup, and D. J. Callans, “Atrial Fibrillation and Heart Failure,” Circulation 119 (2009): 2516–2525, https://doi.org/10.1161/CIRCULATIONAHA.108.821306.
10.1161/CIRCULATIONAHA.108.821306
PubMed Web of Science® Google Scholar
3M. Zoni-Berisso, F. Lercari, T. Carazza, and S. Domenicucci, “Epidemiology of Atrial Fibrillation: European Perspective,” Clinical Epidemiology 6 (2014): 213–220, https://doi.org/10.2147/clep.S47385.
10.2147/CLEP.S47385
PubMed Web of Science® Google Scholar
4W. A. Zoghbi, R. A. Levine, F. Flachskampf, et al., “Atrial Functional Mitral Regurgitation: A JACC: Cardiovascular Imaging Expert Panel Viewpoint,” JACC. Cardiovascular imaging 15 (2022): 1870–1882, https://doi.org/10.1016/j.jcmg.2022.08.016.
10.1016/j.jcmg.2022.08.016
PubMed Web of Science® Google Scholar
5M. Tamargo, M. Obokata, Y. N. V. Reddy, et al., “Functional Mitral Regurgitation and Left Atrial Myopathy in Heart Failure With Preserved Ejection Fraction,” European Journal of Heart Failure 22 (2020): 489–498, https://doi.org/10.1002/ejhf.1699.
10.1002/ejhf.1699
PubMed Web of Science® Google Scholar
6V. Dziadzko, M. Dziadzko, J. R. Medina-Inojosa, et al., “Causes and Mechanisms of Isolated Mitral Regurgitation in the Community: Clinical Context and Outcome,” European Heart Journal 40 (2019): 2194–2202, https://doi.org/10.1093/eurheartj/ehz314.
10.1093/eurheartj/ehz314
PubMed Web of Science® Google Scholar
7C. Saito, Y. Minami, K. Arai, et al., “Prevalence, Clinical Characteristics, and Outcome of Atrial Functional Mitral Regurgitation in Hospitalized Heart Failure Patients With Atrial Fibrillation,” Journal of Cardiology 72 (2018): 292–299, https://doi.org/10.1016/j.jjcc.2018.04.002.
10.1016/j.jjcc.2018.04.002
PubMed Web of Science® Google Scholar
8O. Mesi, M. M. Gad, A. D. Crane, et al., “Severe Atrial Functional Mitral Regurgitation,” JACC: Cardiovascular Imaging 14 (2021): 797–808, https://doi.org/10.1016/j.jcmg.2021.02.008.
10.1016/j.jcmg.2021.02.008
PubMed Web of Science® Google Scholar
9F. Nappi, S. S. Avatar Singh, O. Santana, and C. G. Mihos, “Functional Mitral Regurgitation: An Overview for Surgical Management Framework,” Journal of Thoracic Disease 10 (2018): 4540–4555.
10.21037/jtd.2018.07.07
PubMed Web of Science® Google Scholar
10C. M. Wagner, A. A. Brescia, T. Watt, et al., “Surgical Strategy and Outcomes for Atrial Functional Mitral Regurgitation: All Functional Mitral Regurgitation Is Not the Same!,” Journal of Thoracic and Cardiovascular Surgery 167 (2024): 647–655, https://doi.org/10.1016/j.jtcvs.2022.02.056.
10.1016/j.jtcvs.2022.02.056
PubMed Web of Science® Google Scholar
11S. A. Hirji, C. L. Cote, H. Javadikasgari, A. Malarczyk, S. McGurk, and T. Kaneko, “Atrial Functional Versus Ventricular Functional Mitral Regurgitation: Prognostic Implications,” Journal of Thoracic and Cardiovascular Surgery 164 (2022): 1808–1815.e4, https://doi.org/10.1016/j.jtcvs.2020.12.098.
10.1016/j.jtcvs.2020.12.098
PubMed Web of Science® Google Scholar
12A. Alperi, J. F. Granada, M. Bernier, F. Dagenais, and J. Rodés-Cabau, “Current Status and Future Prospects of Transcatheter Mitral Valve Replacement,” Journal of the American College of Cardiology 77 (2021): 3058–3078, https://doi.org/10.1016/j.jacc.2021.04.051.
10.1016/j.jacc.2021.04.051
PubMed Web of Science® Google Scholar
13S. Nishino, N. Watanabe, K. Ashikaga, et al., “Reverse Remodeling of the Mitral Valve Complex After Radiofrequency Catheter Ablation for Atrial Fibrillation,” Circulation: Cardiovascular Imaging 12 (2019): e009317, https://doi.org/10.1161/CIRCIMAGING.119.009317.
10.1161/CIRCIMAGING.119.009317
PubMed Web of Science® Google Scholar
14Z. M. Gertz, A. Raina, L. Saghy, et al., “Evidence of Atrial Functional Mitral Regurgitation Due to Atrial Fibrillation,” Journal of the American College of Cardiology 58 (2011): 1474–1481, https://doi.org/10.1016/j.jacc.2011.06.032.
10.1016/j.jacc.2011.06.032
PubMed Web of Science® Google Scholar
15G. Valocik, O. Kamp, and C. Visser, “Three-Dimensional Echocardiography in Mitral Valve Disease,” European Journal of Echocardiography 6 (2005): 443–454, https://doi.org/10.1016/j.euje.2005.02.007.
10.1016/j.euje.2005.02.007
PubMed Google Scholar
16S. Nattel and M. Harada, “Atrial Remodeling and Atrial Fibrillation,” Journal of the American College of Cardiology 63 (2014): 2335–2345, https://doi.org/10.1016/j.jacc.2014.02.555.
10.1016/j.jacc.2014.02.555
PubMed Web of Science® Google Scholar
17M. J. Shen, R. Arora, and J. Jalife, “Atrial Myopathy,” JACC. Basic to Translational Science 4 (2019): 640–654, https://doi.org/10.1016/j.jacbts.2019.05.005.
10.1016/j.jacbts.2019.05.005
PubMed Web of Science® Google Scholar
18Y. C. Chen, A. Voskoboinik, A. L. Gerche, T. H. Marwick, and J. R. McMullen, “Prevention of Pathological Atrial Remodeling and Atrial Fibrillation,” Journal of the American College of Cardiology 77 (2021): 2846–2864, https://doi.org/10.1016/j.jacc.2021.04.012.
10.1016/j.jacc.2021.04.012
PubMed Web of Science® Google Scholar
19I. C. Van Gelder, M. Rienstra, K. V. Bunting, et al., “2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio-Thoracic Surgery (EACTS),” European Heart Journal 45 (2024): 3314–3414, https://doi.org/10.1093/eurheartj/ehae176.
10.1093/eurheartj/ehae176
PubMed Web of Science® Google Scholar
20T. A. McDonagh, M. Metra, M. Adamo, et al., “2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure,” European Heart Journal 42 (2021): 3599–3726, https://doi.org/10.1093/eurheartj/ehab368.
10.1093/eurheartj/ehab368
CAS PubMed Web of Science® Google Scholar
21D. J. Lim, B. Ambale-Ventakesh, M. R. Ostovaneh, et al., “Change in Left Atrial Function Predicts Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis,” European Heart Journal - Cardiovascular Imaging 20 (2019): 979–987, https://doi.org/10.1093/ehjci/jez176.
10.1093/ehjci/jez176
Web of Science® Google Scholar
22M. Schaaf, P. Andre, M. Altman, et al., “Left Atrial Remodelling Assessed By 2D and 3D Echocardiography Identifies Paroxysmal Atrial Fibrillation,” European Heart Journal—Cardiovascular Imaging 18 (2017): 46–53, https://doi.org/10.1093/ehjci/jew028.
10.1093/ehjci/jew028
PubMed Web of Science® Google Scholar
23F. Pathan, E. Sivaraj, K. Negishi, et al., “Use of Atrial Strain to Predict Atrial Fibrillation After Cerebral Ischemia,” JACC. Cardiovascular imaging 11 (2018): 1557–1565, https://doi.org/10.1016/j.jcmg.2017.07.027.
10.1016/j.jcmg.2017.07.027
PubMed Web of Science® Google Scholar
24I. E. Hof, B. K. Velthuis, S. M. Chaldoupi, et al., “Pulmonary Vein Antrum Isolation Leads to a Significant Decrease of Left Atrial Size,” Europace 13 (2010): 371–375, https://doi.org/10.1093/europace/euq464.
10.1093/europace/euq464
PubMed Google Scholar
25J. V. Wylie, D. C. Peters, V. Essebag, W. J. Manning, M. E. Josephson, and T. H. Hauser, “Left Atrial Function and Scar After Catheter Ablation of Atrial Fibrillation,” Heart rhythm: the official journal of the Heart Rhythm Society 5 (2008): 656–662, https://doi.org/10.1016/j.hrthm.2008.02.008.
10.1016/j.hrthm.2008.02.008
PubMed Web of Science® Google Scholar
26L. Pype, L. Embrechts, B. Cornez, et al., “Long-Term Effect of Atrial Fibrillation on the Evolution of Mitral and Tricuspid Valve Regurgitation,” Acta Cardiologica 75 (2020): 639–647, https://doi.org/10.1080/00015385.2019.1649339.
10.1080/00015385.2019.1649339
CAS PubMed Web of Science® Google Scholar
27L. Soulat-Dufour, S. Lang, K. Addetia, et al., “Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation,” Journal of the American College of Cardiology 79 (2022): 951–961, https://doi.org/10.1016/j.jacc.2021.12.029.
10.1016/j.jacc.2021.12.029
PubMed Web of Science® Google Scholar
28L. Welikovitch, G. Lafreniere, G. W. Burggraf, and A. J. Sanfilippo, “Change in Atrial Volume Following Restoration of Sinus Rhythm in Patients With Atrial Fibrillation: A Prospective Echocardiographic Study,” Canadian Journal of Cardiology 10 (1994): 993–996.
CAS PubMed Web of Science® Google Scholar
29A. T. M. Gosselink, H. J. G. M. Crijns, H. P. M. Hamer, H. Hillege, and K. I. Lie, “Changes in Left and Right Atrial Size After Cardioversion of Atrial Fibrillation: Role of Mitral Valve Disease,” Journal of the American College of Cardiology 22 (1993): 1666–1672, https://doi.org/10.1016/0735-1097(93)90593-p.
10.1016/0735-1097(93)90593-P
CAS PubMed Web of Science® Google Scholar
30E. Xie, R. Yu, B. Ambale-Venkatesh, et al., “Association of Right Atrial Structure With Incident Atrial Fibrillation: A Longitudinal Cohort Cardiovascular Magnetic Resonance Study From the Multi-Ethnic Study of Atherosclerosis (MESA),” Journal of Cardiovascular Magnetic Resonance 22 (2020): 36, https://doi.org/10.1186/s12968-020-00631-1.
10.1186/s12968-020-00631-1
PubMed Web of Science® Google Scholar
31J. J. Silbiger and R. Bazaz, “Contemporary Insights into the Functional Anatomy of the Mitral Valve,” American Heart Journal 158 (2009): 887–895, https://doi.org/10.1016/j.ahj.2009.10.014.
10.1016/j.ahj.2009.10.014
PubMed Web of Science® Google Scholar
32I. S. Salgo, J. H. Gorman, R. C. Gorman, et al., “Effect of Annular Shape on Leaflet Curvature in Reducing Mitral Leaflet Stress,” Circulation 106 (2002): 711–717, https://doi.org/10.1161/01.cir.0000025426.39426.83.
10.1161/01.CIR.0000025426.39426.83
PubMed Web of Science® Google Scholar
33Z. Tang, Y. T. Fan, Y. Wang, C. N. Jin, K. W. Kwok, and A. P. W. Lee, “Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study,” Journal of the American Society of Echocardiography 32 (2019): 503–513, https://doi.org/10.1016/j.echo.2018.11.009.
10.1016/j.echo.2018.11.009
PubMed Web of Science® Google Scholar
34B. Li, F. Luo, X. Luo, et al., “Effects of Atrial Fibrosis Induced By Mitral Regurgitation on Atrial Electrophysiology and Susceptibility to Atrial Fibrillation in Pigs,” Cardiovascular Pathology 40 (2019): 32–40, https://doi.org/10.1016/j.carpath.2019.01.006.
10.1016/j.carpath.2019.01.006
PubMed Web of Science® Google Scholar
35E. Carluccio, P. Biagioli, A. Mengoni, et al., “Left Atrial Reservoir Function and Outcome in Heart Failure With Reduced Ejection Fraction,” Circulation: Cardiovascular Imaging 11 (2018): e007696, https://doi.org/10.1161/CIRCIMAGING.118.007696.
10.1161/CIRCIMAGING.118.007696
PubMed Web of Science® Google Scholar
36J. Stassen, A. L. van Wijngaarden, S. C. Butcher, et al., “Prognostic Value of Left Atrial Reservoir Function in Patients With Severe Primary Mitral Regurgitation Undergoing Mitral Valve Repair,” European Heart Journal—Cardiovascular Imaging 24 (2022): 142–151, https://doi.org/10.1093/ehjci/jeac058.
10.1093/ehjci/jeac058
PubMed Web of Science® Google Scholar
37J. Stassen, F. Namazi, P. van der Bijl, et al., “Left Atrial Reservoir Function and Outcomes in Secondary Mitral Regurgitation,” Journal of the American Society of Echocardiography 35 (2022): 477–485.e3, https://doi.org/10.1016/j.echo.2022.01.007.
10.1016/j.echo.2022.01.007
PubMed Web of Science® Google Scholar
38D. Cramariuc, H. Alfraidi, Y. Nagata, et al., “Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications,” Circulation: Cardiovascular Imaging 16 (2023): e015089, https://doi.org/10.1161/circimaging.122.015089.
10.1161/CIRCIMAGING.122.015089
PubMed Web of Science® Google Scholar
39Y. Abe, Y. Takahashi, and T. Shibata, “Functional Mitral Regurgitation, Updated: Ventricular or Atrial?,” Journal of Echocardiography 18 (2020): 1–8, https://doi.org/10.1007/s12574-019-00453-w.
10.1007/s12574-019-00453-w
PubMed Web of Science® Google Scholar
40J. J. Silbiger, “Does Left Atrial Enlargement Contribute to Mitral Leaflet Tethering in Patients With Functional Mitral Regurgitation? Proposed Role of Atriogenic Leaflet Tethering,” Echocardiography 31 (2014): 1310–1311, https://doi.org/10.1111/echo.12629.
10.1111/echo.12629
PubMed Web of Science® Google Scholar
41J. P. Dal-Bianco, E. Aikawa, J. Bischoff, et al., “Active Adaptation of the Tethered Mitral Valve: Insights Into a Compensatory Mechanism for Functional Mitral Regurgitation,” Circulation 120 (2009): 334–342, https://doi.org/10.1161/circulationaha.108.846782.
10.1161/CIRCULATIONAHA.108.846782
PubMed Web of Science® Google Scholar
42E. J. Armstrong and J. Bischoff, “Heart Valve Development: Endothelial Cell Signaling and Differentiation,” Circulation Research 95 (2004): 459–470, https://doi.org/10.1161/01.RES.0000141146.95728.da.
10.1161/01.RES.0000141146.95728.da
CAS PubMed Web of Science® Google Scholar
43L. Ring, D. P. Dutka, F. C. Wells, S. P. Fynn, L. M. Shapiro, and B. S. Rana, “Mechanisms of Atrial Mitral Regurgitation: Insights Using 3D Transoesophageal Echo,” European Heart Journal—Cardiovascular Imaging 15 (2014): 500–508, https://doi.org/10.1093/ehjci/jet191.
10.1093/ehjci/jet191
PubMed Web of Science® Google Scholar
44N. Kagiyama, A. Hayashida, M. Toki, et al., “Insufficient Leaflet Remodeling in Patients With Atrial Fibrillation,” Circulation: Cardiovascular Imaging 10 (2017): e005451, https://doi.org/10.1161/CIRCIMAGING.116.005451.
10.1161/CIRCIMAGING.116.005451
PubMed Web of Science® Google Scholar
45D. H. Kim, R. Heo, M. D. Handschumacher, et al., “Mitral Valve Adaptation to Isolated Annular Dilation,” JACC: Cardiovascular Imaging 12 (2019): 665–677, https://doi.org/10.1016/j.jcmg.2017.09.013.
10.1016/j.jcmg.2017.09.013
PubMed Web of Science® Google Scholar
46A. Vahanian, F. Beyersdorf, F. Praz, et al., “2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease,” European Heart Journal 43 (2022): 561–632, https://doi.org/10.1093/eurheartj/ehab395.
10.1093/eurheartj/ehab395
PubMed Web of Science® Google Scholar
47C. M. Otto, R. A. Nishimura, R. O. Bonow, et al., “2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines,” Circulation 143 (2021): e72–e227, https://doi.org/10.1161/cir.0000000000000923.
10.1161/cir.0000000000000923
PubMed Web of Science® Google Scholar
48T. A. McDonagh, M. Metra, M. Adamo, et al., “2023 Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure,” European Heart Journal 44 (2023): 3627–3639, https://doi.org/10.1093/eurheartj/ehad195.
10.1093/eurheartj/ehad195
CAS PubMed Web of Science® Google Scholar
49D.-H. Kang, S. J. Park, S. H. Shin, et al., “Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation,” Circulation 139 (2019): 1354–1365, https://doi.org/10.1161/CIRCULATIONAHA.118.037077.
10.1161/CIRCULATIONAHA.118.037077
CAS PubMed Web of Science® Google Scholar
50Y. W. Lin, C. Y. Chen, J. Y. Shih, et al., “Dapagliflozin Improves Cardiac Hemodynamics and Mitigates Arrhythmogenesis in Mitral Regurgitation-Induced Myocardial Dysfunction,” Journal of the American Heart Association 10 (2021): e019274, https://doi.org/10.1161/JAHA.120.019274.
10.1161/JAHA.120.019274
PubMed Web of Science® Google Scholar
51Y. Fan, S. Wan, R. H. L. Wong, and A. P. W. Lee, “Atrial Functional Mitral Regurgitation: Mechanisms and Surgical Implications,” Asian Cardiovascular and Thoracic Annals 28 (2020): 421–426, https://doi.org/10.1177/0218492320941388.
10.1177/0218492320941388
PubMed Google Scholar
52A. Amabile, S. Fereydooni, M. Mori, et al., “Variable Definitions and Treatment Approaches for Atrial Functional Mitral Regurgitation: A Scoping Review of the Literature,” Journal of Cardiac Surgery 37 (2022): 1182–1191, https://doi.org/10.1111/jocs.16312.
10.1111/jocs.16312
PubMed Web of Science® Google Scholar
53H. A. Vohra, R. N. Whistance, A. Magan, S. A. Sadeque, and S. A. Livesey, “Mitral Valve Repair for Severe Mitral Regurgitation Secondary to Lone Atrial Fibrillation,” European Journal of Cardio-Thoracic Surgery 42 (2012): 634–637, https://doi.org/10.1093/ejcts/ezs029.
10.1093/ejcts/ezs029
PubMed Web of Science® Google Scholar
54Y. Takahashi, Y. Abe, Y. Sasaki, et al., “Mitral Valve Repair for Atrial Functional Mitral Regurgitation in Patients With Chronic Atrial Fibrillation,” Interactive Cardiovascular and Thoracic Surgery 21 (2015): 163–168, https://doi.org/10.1093/icvts/ivv119.
10.1093/icvts/ivv119
PubMed Web of Science® Google Scholar
55T. Sakaguchi, T. Totsugawa, K. Orihashi, et al., “Mitral Annuloplasty for Atrial Functional Mitral Regurgitation in Patients With Chronic Atrial Fibrillation,” Journal of Cardiac Surgery 34 (2019): 767–773, https://doi.org/10.1111/jocs.14136.
10.1111/jocs.14136
PubMed Web of Science® Google Scholar
56T. Salvatore, F. Ricci, G. D. Dangas, et al., “Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology,” Frontiers in Cardiovascular Medicine 8 (2021), https://doi.org/10.3389/fcvm.2021.585415.
10.3389/fcvm.2021.585415
PubMed Web of Science® Google Scholar
57A. P. W. Lee, M. Acker, S. H. Kubo, et al., “Mechanisms of Recurrent Functional Mitral Regurgitation After Mitral Valve Repair in Nonischemic Dilated Cardiomyopathy: Importance of Distal Anterior Leaflet Tethering,” Circulation 119 (2009): 2606–2614, https://doi.org/10.1161/circulationaha.108.796151.
10.1161/CIRCULATIONAHA.108.796151
PubMed Web of Science® Google Scholar
58E. Agricola, F. Meucci, F. Ancona, A. Pardo Sanz, and J. L. Zamorano, “Echocardiographic Guidance in Transcatheter Structural Cardiac Interventions,” EuroIntervention 17 (2022): 1205–1226, https://doi.org/10.4244/eij-d-21-00582.
10.4244/EIJ-D-21-00582
PubMed Web of Science® Google Scholar
59A. Popolo Rubbio, L. Testa, C. Grasso, et al., “Transcatheter Edge-To-Edge Mitral Valve Repair in Atrial Functional Mitral Regurgitation: Insights From the Multi-Center MITRA-TUNE Registry,” International Journal of Cardiology 349 (2022): 39–45, https://doi.org/10.1016/j.ijcard.2021.11.027.
10.1016/j.ijcard.2021.11.027
PubMed Google Scholar
60T. Benito-González, F. Carrasco-Chinchilla, R. Estévez-Loureiro, et al., “Clinical and Echocardiographic Outcomes of Transcatheter Mitral Valve Repair in Atrial Functional Mitral Regurgitation,” International Journal of Cardiology 345 (2021): 29–35, https://doi.org/10.1016/j.ijcard.2021.09.056.
10.1016/j.ijcard.2021.09.056
PubMed Web of Science® Google Scholar
61I. Pascual, D. Arzamendi, F. Carrasco-Chinchilla, et al., “Reparación Mitral Transcatéter Según La Etiología De La Insuficiencia Mitral: Datos De La Vida Real Procedentes Del Registro Español De Mitraclip,” Revista española de cardiología 73 (2020): 643–651, https://doi.org/10.1016/j.rec.2019.07.018.
10.1016/j.recesp.2019.07.014
PubMed Google Scholar
62P. Doldi, L. Stolz, M. Orban, et al., “Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation,” JACC: Cardiovascular Imaging 15 (2022): 1843–1851, https://doi.org/10.1016/j.jcmg.2022.05.009.
10.1016/j.jcmg.2022.05.009
PubMed Web of Science® Google Scholar
63N. Sodhi, F. M. Asch, T. Ruf, et al., “Clinical Outcomes With Transcatheter Edge-to-Edge Repair in Atrial Functional MR From the EXPAND Study,” JACC: Cardiovascular Interventions 15 (2022): 1723–1730, https://doi.org/10.1016/j.jcin.2022.07.023.
10.1016/j.jcin.2022.07.023
PubMed Web of Science® Google Scholar
64T. Tanaka, A. Sugiura, J. Vogelhuber, et al., “Outcomes of Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation,” EuroIntervention 20 (2024): e250–e260, https://doi.org/10.4244/eij-d-23-00819.
10.4244/EIJ-D-23-00819
PubMed Web of Science® Google Scholar
65S. Hamada, H. Ueyama, T. Aikawa, et al., “Outcomes of Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation: A Meta-Analysis of Observational Studies,” Catheterization and Cardiovascular Interventions 102 (2023): 751–760, https://doi.org/10.1002/ccd.30806.
10.1002/ccd.30806
PubMed Web of Science® Google Scholar
66C. Toprak, G. Kahveci, A. Kilicgedik, et al., “Left Atrial Remodeling in Patients Undergoing Percutaneous Mitral Valve Repair With the Mitraclip System: An Advanced Echocardiography Study,” Echocardiography 33 (2016): 1504–1511, https://doi.org/10.1111/echo.13288.
10.1111/echo.13288
PubMed Web of Science® Google Scholar
67A. Albini, M. Passiatore, J. F. Imberti, et al., “Ventricular and Atrial Remodeling After Transcatheter Edge-to-Edge Repair: A Pilot Study,” Journal of Personalized Medicine 12 (2022): 1916, https://doi.org/10.3390/jpm12111916.
10.3390/jpm12111916
PubMed Web of Science® Google Scholar
68M. Ali, S. S. Shreenivas, D. N. Pratt, D. R. Lynch, and D. J. Kereiakes, “Percutaneous Interventions for Secondary Mitral Regurgitation,” Circulation: Cardiovascular Interventions 13 (2020): e008998, https://doi.org/10.1161/CIRCINTERVENTIONS.120.008998.
10.1161/CIRCINTERVENTIONS.120.008998
PubMed Web of Science® Google Scholar
69S. Deferm, P. B. Bertrand, F. H. Verbrugge, et al., “Atrial Functional Mitral Regurgitation,” Journal of the American College of Cardiology 73 (2019): 2465–2476, https://doi.org/10.1016/j.jacc.2019.02.061.
10.1016/j.jacc.2019.02.061
PubMed Web of Science® Google Scholar
70D. Rottländer, M. Gödde, H. Degen, A. Ögütcü, and M. Haude, “Percutaneous Coronary Sinus–Based Mitral Valve Annuloplasty in Atrial Functional Mitral Regurgitation,” JACC: Cardiovascular Interventions 13 (2020): 2947–2949, https://doi.org/10.1016/j.jcin.2020.09.019.
10.1016/j.jcin.2020.09.019
PubMed Web of Science® Google Scholar
71D. Rottländer, M. Golabkesh, H. Degen, A. Ögütcü, M. Saal, and M. Haude, “Mitral Valve Edge-to-Edge Repair Versus Indirect Mitral Valve Annuloplasty in Atrial Functional Mitral Regurgitation,” Catheterization and Cardiovascular Interventions 99 (2022): 1839–1847, https://doi.org/10.1002/ccd.30157.
10.1002/ccd.30157
PubMed Web of Science® Google Scholar
72G. Hindricks, T. Potpara, N. Dagres, et al., “2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed With the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC,” European Heart Journal 42 (2021): 373–498, https://doi.org/10.1093/eurheartj/ehaa612.
10.1093/eurheartj/ehaa612
PubMed Web of Science® Google Scholar
73M. K. Turagam, D. Musikantow, W. Whang, et al., “Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-Line Therapy of Atrial Fibrillation: A Meta-Analysis of Randomized Clinical Trials,” JAMA Cardiology 6 (2021): 697–705, https://doi.org/10.1001/jamacardio.2021.0852.
10.1001/jamacardio.2021.0852
PubMed Web of Science® Google Scholar
74D. L. Packer, D. B. Mark, R. A. Robb, et al., “Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial,” Journal of the American Medical Association 321 (2019): 1261–1274, https://doi.org/10.1001/jama.2019.0693.
10.1001/jama.2019.0693
CAS PubMed Web of Science® Google Scholar
75L. Zhao, W. Jiang, L. Zhou, et al., “The Role of Valvular Regurgitation in Catheter Ablation Outcomes of Patients With Long-Standing Persistent Atrial Fibrillation,” Europace 16 (2014): 848–854, https://doi.org/10.1093/europace/eut252.
10.1093/europace/eut252
PubMed Web of Science® Google Scholar
76Y. Abe, K. Akamatsu, K. Ito, et al., “Prevalence and Prognostic Significance of Functional Mitral and Tricuspid Regurgitation Despite Preserved Left Ventricular Ejection Fraction in Atrial Fibrillation Patients,” Circulation Journal 82 (2018): 1451–1458, https://doi.org/10.1253/circj.CJ-17-1334.
10.1253/circj.CJ-17-1334
PubMed Web of Science® Google Scholar
77Z. M. Gertz, A. Raina, S. E. Mountantonakis, et al., “The Impact of Mitral Regurgitation on Patients Undergoing Catheter Ablation of Atrial Fibrillation,” Europace 13 (2011): 1127–1132, https://doi.org/10.1093/europace/eur098.
10.1093/europace/eur098
PubMed Web of Science® Google Scholar
78S. Nishino, N. Watanabe, K. Ashikaga, et al., “Reverse Remodeling of the Mitral Valve Complex After Radiofrequency Catheter Ablation for Atrial Fibrillation: A Serial 3-Dimensional Echocardiographic Study,” Circulation: Cardiovascular Imaging 12 (2019): e009317, https://doi.org/10.1161/CIRCIMAGING.119.009317.
10.1161/CIRCIMAGING.119.009317
PubMed Web of Science® Google Scholar
79E. O. Udo and R. J. Hassink, “Pulmonary Vein Isolation as a Treatment for Severe Atrial Functional Mitral Regurgitation in a Patient With Atrial Fibrillation,” International Journal of Cardiology 175 (2014): 578–579, https://doi.org/10.1016/j.ijcard.2014.05.025.
10.1016/j.ijcard.2014.05.025
CAS PubMed Web of Science® Google Scholar
80M. Takigawa, T. Kuwahara, A. Takahashi, et al., “The Mechanism of Mitral Regurgitation Assessed by Preprocedural Echocardiography Is Associated With the Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation,” Journal of Interventional Cardiac Electrophysiology 46 (2016): 299–306, https://doi.org/10.1007/s10840-016-0123-8.
10.1007/s10840-016-0123-8
PubMed Web of Science® Google Scholar
81A. W. Teh, P. M. Kistler, G. Lee, et al., “Electroanatomic Remodeling of the Left Atrium in Paroxysmal and Persistent Atrial Fibrillation Patients Without Structural Heart Disease,” Journal of Cardiovascular Electrophysiology 23 (2012): 232–238, https://doi.org/10.1111/j.1540-8167.2011.02178.x.
10.1111/j.1540-8167.2011.02178.x
PubMed Web of Science® Google Scholar
82A. W. Teh, P. M. Kistler, G. Lee, et al., “Long-Term Effects of Catheter Ablation for Lone Atrial Fibrillation: Progressive Atrial Electroanatomic Substrate Remodeling Despite Successful Ablation,” Heart Rhythm 9 (2012): 473–480, https://doi.org/10.1016/j.hrthm.2011.11.013.
10.1016/j.hrthm.2011.11.013
PubMed Web of Science® Google Scholar
83S. Prabhu, A. Voskoboinik, A. J. A. McLellan, et al., “Biatrial Electrical and Structural Atrial Changes in Heart Failure,” JACC: Clinical Electrophysiology 4 (2018): 87–96, https://doi.org/10.1016/j.jacep.2017.08.012.
10.1016/j.jacep.2017.08.012
PubMed Web of Science® Google Scholar
84M. Talajic, P. Khairy, S. Levesque, et al., “Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation,” Journal of the American College of Cardiology 55 (2010): 1796–1802, https://doi.org/10.1016/j.jacc.2010.01.023.
10.1016/j.jacc.2010.01.023
PubMed Web of Science® Google Scholar
85D. Roy, M. Talajic, S. Nattel, et al., “Rhythm Control Versus Rate Control for Atrial Fibrillation and Heart Failure,” New England Journal of Medicine 358 (2008): 2667–2677, https://doi.org/10.1056/NEJMoa0708789.
10.1056/NEJMoa0708789
CAS PubMed Web of Science® Google Scholar
86N. F. Marrouche, J. Brachmann, D. Andresen, et al., “Catheter Ablation for Atrial Fibrillation With Heart Failure,” New England Journal of Medicine 378 (2018): 417–427, https://doi.org/10.1056/NEJMoa1707855.
10.1056/NEJMoa1707855
PubMed Web of Science® Google Scholar
87S. Prabhu, B. T. Costello, A. J. Taylor, et al., “Regression of Diffuse Ventricular Fibrosis Following Restoration of Sinus Rhythm With Catheter Ablation inPatients With Atrial Fibrillation and Systolic Dysfunction,” JACC: Clinical Electrophysiology 4 (2018): 999–1007, https://doi.org/10.1016/j.jacep.2018.04.013.
10.1016/j.jacep.2018.04.013
PubMed Google Scholar
88H. Sugumar, S. Prabhu, A. Voskoboinik, et al., “Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy,” JACC: Clinical Electrophysiology 5 (2019): 681–688, https://doi.org/10.1016/j.jacep.2019.03.009.
10.1016/j.jacep.2019.03.009
PubMed Web of Science® Google Scholar
89J. T. Wu, J. A. B. Zaman, H. Y. Yakupoglu, et al., “Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction,” Frontiers in Cardiovascular Medicine 7 (2020): 596491, https://doi.org/10.3389/fcvm.2020.596491.
10.3389/fcvm.2020.596491
PubMed Web of Science® Google Scholar
90M. Masuda, K. Sekiya, M. Asai, et al., “Influence of Catheter Ablation for Atrial Fibrillation on Atrial and Ventricular Functional Mitral Regurgitation,” ESC Heart Failure 9 (2022): 1901–1913, https://doi.org/10.1002/ehf2.13896.
10.1002/ehf2.13896
PubMed Web of Science® Google Scholar
91R. Lee, P. M. McCarthy, E. C. Wang, et al., “Midterm Survival in Patients Treated for Atrial Fibrillation: A Propensity-Matched Comparison to Patients Without a History of Atrial Fibrillation,” Journal of Thoracic and Cardiovascular Surgery 143 (2012): 1341–1351, discussion 1350-1341, https://doi.org/10.1016/j.jtcvs.2012.02.006.
10.1016/j.jtcvs.2012.02.006
PubMed Web of Science® Google Scholar
92A. M. Gillinov, A. C. Gelijns, M. K. Parides, et al., “Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery,” New England Journal of Medicine 372 (2015): 1399–1409, https://doi.org/10.1056/NEJMoa1500528.
10.1056/NEJMoa1500528
CAS PubMed Web of Science® Google Scholar
93J. Chen, Y. Wang, M. Lv, et al., “Mitral Valve Repair and Surgical Ablation for Atrial Functional Mitral Regurgitation,” Annals of Translational Medicine 8 (2020): 1420, https://doi.org/10.21037/atm-20-2958.
10.21037/atm-20-2958
PubMed Web of Science® Google Scholar
94M. Marini, L. Pannone, D. G. Della Rocca, et al., “Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview,” Journal of Cardiovascular Development and Disease 9 (2022): 302, https://doi.org/10.3390/jcdd9090302.
10.3390/jcdd9090302
PubMed Web of Science® Google Scholar
95A. Preda, F. Carbone, A. Tirandi, F. Montecucco, and L. Liberale, “Obesity Phenotypes and Cardiovascular Risk: From Pathophysiology to Clinical Management,” Reviews in Endocrine and Metabolic Disorders 24 (2023): 901–919, https://doi.org/10.1007/s11154-023-09813-5.
10.1007/s11154-023-09813-5
CAS PubMed Web of Science® Google Scholar
96A. Preda, F. Giordano, V. Giani, F. Guarracini, and P. Mazzone, “Accelerated Adverse Atrial Remodeling in Women With Atrial Fibrillation: Results From Studies Using Electroanatomic Mapping Systems,” American Journal of Cardiology 203 (2023): 524–525, https://doi.org/10.1016/j.amjcard.2023.07.124.
10.1016/j.amjcard.2023.07.124
PubMed Web of Science® Google Scholar
97S. Farhan, J. J. Silbiger, J. L. Halperin, et al., “Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation,” Journal of the American College of Cardiology 80 (2022): 2314–2330, https://doi.org/10.1016/j.jacc.2022.09.046.
10.1016/j.jacc.2022.09.046
PubMed Web of Science® Google Scholar
98D. Braun, M. Näbauer, S. Massberg, and J. Hausleiter, “One-Stop Shop: Simultaneous Direct Mitral Annuloplasty and Percutaneous Mitral Edge-To-Edge Repair in a Patient With Severe Mitral Regurgitation,” Catheterization and Cardiovascular Interventions 93 (2019): E318–e319, https://doi.org/10.1002/ccd.27848.
10.1002/ccd.27848
PubMed Web of Science® Google Scholar
99S. S. Balasubramanian, S. Siddamsetti, and S. Gautam, “Abstract 12646: Cryoablation vs. Radiofrequency Ablation in Persistent AFib: An Updated Meta-Analysis,” Circulation 144 (2021): A12646, https://doi.org/10.1161/circ.144.suppl_1.12646.
10.1161/circ.144.suppl_1.12646
Google Scholar
100R. V. Davalos, L. M. Mir, and B. Rubinsky, “Tissue Ablation With Irreversible Electroporation,” Annals of Biomedical Engineering 33 (2005): 223–231, https://doi.org/10.1007/s10439-005-8981-8.
10.1007/s10439-005-8981-8
CAS PubMed Web of Science® Google Scholar
101A. Verma, C. Jiang, T. R. Betts, et al., “Approaches to Catheter Ablation for Persistent Atrial Fibrillation,” New England Journal of Medicine 372 (2015): 1812–1822, https://doi.org/10.1056/NEJMoa1408288.
10.1056/NEJMoa1408288
PubMed Web of Science® Google Scholar

Volume106, Issue1

July 1, 2025

Pages 28-40

SCAI Member Sign in

Transcatheter Approaches to Atrial Functional Mitral Regurgitation: How Far Have We Come?

ABSTRACT

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Transcatheter Approaches to Atrial Functional Mitral Regurgitation: How Far Have We Come?

ABSTRACT

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

Information