Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis
Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation.
Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation.
Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6mm and ³ 6mm. Kaplan–Meier analysis showed in patients with tethering height < 6mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ³ 6mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group.
Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.
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Posted 21 Sep, 2020
On 29 Sep, 2020
On 20 Sep, 2020
On 14 Sep, 2020
On 13 Sep, 2020
On 13 Sep, 2020
On 23 Aug, 2020
Received 10 Aug, 2020
On 08 Aug, 2020
On 08 Aug, 2020
Received 21 Jun, 2020
Invitations sent on 07 Jun, 2020
On 07 Jun, 2020
On 06 Apr, 2020
On 05 Apr, 2020
On 05 Apr, 2020
On 03 Apr, 2020
Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis
Posted 21 Sep, 2020
On 29 Sep, 2020
On 20 Sep, 2020
On 14 Sep, 2020
On 13 Sep, 2020
On 13 Sep, 2020
On 23 Aug, 2020
Received 10 Aug, 2020
On 08 Aug, 2020
On 08 Aug, 2020
Received 21 Jun, 2020
Invitations sent on 07 Jun, 2020
On 07 Jun, 2020
On 06 Apr, 2020
On 05 Apr, 2020
On 05 Apr, 2020
On 03 Apr, 2020
Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation.
Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation.
Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6mm and ³ 6mm. Kaplan–Meier analysis showed in patients with tethering height < 6mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ³ 6mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group.
Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.
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