Triple Percutaneous Therapy for Mitral Regurgitation and Atrial Fibrillation.

BACKGROUND

Patients with severe mitral regurgitation (MR), atrial fibrillation (AF), and contraindications to long-term anticoagulation often require multiple interventions. The feasibility of combining mitral transcatheter edge-to-edge repair, left atrial appendage closure (LAAC), and AF ablation in a single session is unknown.

CASE SUMMARY: A 78-year-old woman with dilated cardiomyopathy, severe functional MR, and high-burden paroxysmal AF underwent a single-session procedure including pulsed-field AF ablation, mitral transcatheter edge-to-edge repair, and LAAC. Pulmonary veins were isolated, a MitraClip was deployed at A2-P2 with marked MR reduction, and a Watchman device was successfully implanted. The patient remained hemodynamically stable without complications, and follow-up confirmed effective MR reduction, complete LAAC, and maintenance of sinus rhythm.

DISCUSSION: This case demonstrates the feasibility and safety of a combined single-session approach in selected high-risk patients.

TAKE-HOME MESSAGES: A one-stop procedure can simultaneously address valvular disease, rhythm control, and stroke prevention. Multidisciplinary planning and operator expertise are essential for procedural success.