Introduction: There is a recognized association between atrial fibrillation (AF) and isolated functional tricuspid regurgitation (FTR). In contrast to FTR related to pulmonary hypertension (PH) and left heart disease (LHD), FTR-AF patients have fewer cardiopulmonary co-morbidities.
Hypothesis: Whether isolated FTR impacts the clinical course in AF patients has not been characterized. Surgery is the only definitive corrective therapy, but is associated with very high mortality. Given the risks of stand-alone surgery, and the absence of significant comorbidities which may increase operative risk, understanding the clinical course of AF-FTR is critical to establishing the role of corrective interventions.
Methods: From 2005-2009 local residents with AF and ≥ moderate-severe TR were retrospectively identified. Patients with ≥ moderate-severe aortic or mitral disease, pacemaker leads, congenital heart disease, EF <50%, and pulmonary systolic pressure > 50 mmHg were excluded. Survival was compared to predicted survival using a population of age and sex matched controls from the census bureau.
Results: 105 patients with FTR-AF were identified; the mean age at diagnosis was 81.5 years, 77% were female, the mean ejection fraction was 62%, and the mean pulmonary systolic pressure was 35 mmHg. Observed 5-year survival was 49%, and this was significantly lower than predicted survival (63%, P<0.001, Figure 1). Cardiac death occurred in 43% of the study patients.
Conclusions: AF may represent a major cause of isolated functional TR. Although these patients lack significant left heart disease or pulmonary hypertension, observed mortality is higher than expected. It is unclear whether AF or TR is responsible for this excess mortality. Further research into the relationship between TR and AF is needed.