[Atrial fibrillation in combination with severe mitral regurgitation : Which should be treated first, the atrial fibrillation or the mitral valve?].

BACKGROUND

The primary therapeutic approach for severe secondary mitral regurgitation (MR) in combination with atrial fibrillation is often not clear.

OBJECTIVES/METHODS: To create a therapeutic guideline for daily clinical practice based on a case report as well as basic literature.

RESULTS

If a functional component is suspected, restoration of sinus rhythm may lead to a significant improvement in MR. The extent of the improvement and the time required to achieve this improvement are often difficult to predict.

CONCLUSIONS

The involvement of an electrophysiologist is recommended in order to assess the likelihood of successful long-term rhythm control aimed at improving MR. In unclear cases, cardioversion combined with short-term administration of antiarrhythmic medication may be useful to demonstrate potential improvement of MR in sinus rhythm.