Tricuspid Regurgitation, the last challenge left.
Abstract
Atrial fibrillation (AF) provides extremel rapid excitation frequency in
both atria, and induces several pathophysiological mechanisms by
influencing each other to promote AF. This auto-enhancing feature is
often described by the well-known concept “AF begets AF”. The cure of
AF by creating pulmonary vein (PV) isolation may be able to reverse the
spiral and be able to achieve reverse remodeling. Because of the initial
focus on PV in the pathogenesis of AF, the effects of reverse remodeling
after catheter ablation (CA) have been investigated on improvement of
the left-sided cardiac system. On the other hand, tricuspid
regurgitation (TR), the most neglected of all valvular diseases, is
increasingly recognized as an important prognostic condition in heart
failure patients. Previous reports, which tested the role of CA for AF
patients with TR, have demonstrated that maintenance of SR provides
reverse remodeling of the right-sided cardiac system, but have yet to
prove whether this leads to improvement in patient prognosis. What is
new and noteworthy about the report by Ukita et al. in this issue is
that they found that TR improvement itself improves major event-free
survival rate (incidence of heart failure hospitalization and all-cause
mortality). However, several issues remain unresolved in their report.
They observed a low AF recurrence rate in the TR-improved group, but did
not address the possibility that AF suppression itself contributed to
improve event-free survival rate. Further investigation is required to
clarify whether TR improvement or maintenance of SR is the greater
contributor to improved prognosis in AF.