Clinical outcomes of catheter ablation vs transcatheter edge-to-edge repair as the initial intervention strategy in patients with atrial fibrillation and functional mitral regurgitation.

BACKGROUND

Atrial fibrillation (AF) and functional mitral regurgitation (FMR) frequently coexist and are linked through shared mechanisms of atrial and ventricular remodeling. Both catheter ablation and transcatheter edge-to-edge mitral valve repair (M-TEER) improve clinical status, yet the optimal sequence of these interventions remains unclear.

OBJECTIVE

This study evaluated real-world outcomes in patients with AF and FMR, comparing catheter ablation and M-TEER as initial strategies, with a focus on mitral regurgitation (MR) severity, symptom stability, all-cause mortality, and all-cause cardiac hospitalizations.

METHODS

We performed a single-center retrospective analysis of patients with AF and moderate to moderate-to-severe FMR. Patients were grouped according to the initial treatment strategy: AF ablation or M-TEER. Clinical and echocardiographic data were reviewed at baseline and follow-up. A 2-year retrospective follow-up was performed to evaluate changes in MR severity, symptom stability, all-cause mortality, and all-cause cardiac hospitalizations.

RESULTS

A total of 281 patients were included (M-TEER, n = 129; AF ablation, n = 152). MR severity improved more frequently after M-TEER (P < .001). However, AF ablation was associated with better symptom stability (69% vs 44%; P < .001), markedly lower all-cause mortality (3% vs 14%; P = .002), less all-cause cardiac hospitalizations (P = .019), and significant improvement in left ventricular ejection fraction at follow-up (53% ± 11.1% vs 47% ± 13.9%; P < .001).

CONCLUSION

M-TEER was associated with greater MR reduction, while AF ablation was associated with more favorable clinical outcomes. These findings likely reflect stage-dependent management rather than treatment superiority and require confirmation in prospective studies.