Dinov Borislav, Sossalla Samuel, Tsianakas Nikolaos, Piayda Kerstin
Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, Giessen 35392, Germany.
Department of Cardiology, Kerckhoff Heart Center, Beneke Str. 2-8, Bad Nauheim 61231, Germany.
Eur Heart J Case Rep. 2025 Aug 13;9(8):ytaf397. doi: 10.1093/ehjcr/ytaf397. eCollection 2025 Aug.
Atrial fibrillation (AF) and functional mitral regurgitation (FMR) frequently coexist. Surgical treatment or transcatheter edge-to-edge repair is the standard of care for severe FMR. In patients with atrial FMR (aFMR), atrial fibrillation is an important precipitating factor. Since catheter ablation (CA) is a safe and effective treatment of AF, it has been suggested that it may decrease the severity of aFMR. However, data are scarce and the mechanisms of aFMR improvement are not completely understood.
We describe a case of an 86-year-old female with a history of AF and previous pulmonary vein isolation presenting with symptoms of acutely decompensated heart failure and recurrence of atrial flutter. Her echocardiography demonstrated non-dilated left ventricle with a normal ejection fraction, left atrial (LA) dilatation, severe FMR, and tricuspid regurgitation (TR). Due to failed electrical cardioversion and amiodarone intolerance, a successful catheter ablation of a LA flutter was performed. Electro-anatomical mapping revealed extensive LA low-voltage areas. During the follow-up of 18 months, the patient remained in sinus rhythm, and the FMR improved to MR II (effective regurgitant orifice area of 9 mm and regurgitant volume of 18 mL); no improvement of the TR occurred.
Catheter ablation can restore sinus rhythm, decrease LA volume, and improve the severity of atrial FMR. Reverse LA electrical remodelling plays a minor role in the amelioration of MR. Lack of improvement of the TR suggests a different mechanism of TR.
心房颤动（AF）与功能性二尖瓣反流（FMR）常并存。外科治疗或经导管缘对缘修复是重度FMR的标准治疗方法。在伴有心房性FMR（aFMR）的患者中，心房颤动是一个重要的诱发因素。由于导管消融（CA）是治疗AF的一种安全有效的方法，有人提出它可能会降低aFMR的严重程度。然而，相关数据较少，且aFMR改善的机制尚未完全明确。
我们描述了一例86岁女性患者，有AF病史且曾行肺静脉隔离术，现出现急性失代偿性心力衰竭症状及心房扑动复发。她的超声心动图显示左心室未扩张，射血分数正常，左心房（LA）扩张，重度FMR及三尖瓣反流（TR）。因电复律失败且对胺碘酮不耐受，成功进行了LA扑动的导管消融。电解剖标测显示LA广泛低电压区。在18个月的随访期间，患者维持窦性心律，FMR改善为二尖瓣反流II级（有效反流口面积为9mm，反流容积为18mL）；TR无改善。
导管消融可恢复窦性心律，减小LA容积，并改善心房性FMR的严重程度。LA逆向电重构在二尖瓣反流改善中起次要作用。TR无改善提示TR存在不同机制。
