Thoracoscopic surgical ablation for atrial fibrillation patients with functional regurgitation: the treatment strategy prioritizing atrial fibrillation

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BACKGROUND: Atrial fibrillation (AF) and functional regurgitation (FR) have complex interactions. This study investigated the interactions between thoracoscopic surgical ablation (TSA) and FR in patients with AF, to explore whether the strategy prioritizing AF can treat FR, thus avoiding additional valve surgeries. METHODS: A total of 152 AF patients underwent isolated TSA were included for a 12-month follow-up. Among them, the control group contains 67 patients with no valve disease, and the FR group contains 85 patients diagnosed as functional mitral regurgitation (FMR, n = 50) and/or functional tricuspid regurgitation (FTR, n = 75). The changes in the degrees of regurgitation, the recurrence rate of AF 12 months after surgery, and the occurrence of cardiac reverse remodeling were statistically analyzed. Logistic regression analyses were performed to identify variables associated with the reduction in regurgitation. RESULTS: The difference in 12-month sinus rhythm (SR) maintenance rate between the FR group and the control group was not significant (61.18% vs. 74.62%, P = 0.08). FMR degree was reduced significantly ( P < 0.05) while FTR degree was not ( P = 0.66), and the reduction in FTR is related to the reduction in FMR (OR = 19.80, 95% CI 2.22-176.60, P < 0.05) among the patients with both. Significant cardiac reverse remodeling and heart function improvement were observed after TSA (e.g. preoperative vs. postoperative: LV: 47.82 ± 5.37 mm vs. 46.52 ± 5.17 mm, P < 0.05; LA: 42.73 ± 5.41 mm vs. 40.79 ± 6.57 mm, P < 0.05). Logistic regression analyses revealed that the variation in left ventricular posterior wall, the variation in pulmonary artery pressure (PAP) and SR maintenance are associated with FMR reduction ( P < 0.05), while preoperative interventricular septum, the variation in PAP and preoperative FTR degree are associated with FTR reduction ( P < 0.05). CONCLUSIONS: The treatment strategy prioritizing AF is reasonable for patients with AF and FMR. The existence of mild to moderate FR cannot affect TSA results, while TSA can reduce the degree of FMR through cardiac reverse remodeling. And the reduction in FTR is secondary to the PAP decrease after FMR reduction.

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