Comparison of Functional Tricuspid Regurgitation Following Transcatheter Atrial Septal Defect Closure in Adult Patients with Sinus Rhythm, Post-ablation Sinus Rhythm, and Permanent Atrial Fibrillation.

Abstract

The changes in tricuspid regurgitation (TR) following transcatheter atrial septal defect (ASD) closure, in relation to pre-procedural cardiac rhythms, remain unknown. This study aimed to assess sequential changes in TR after ASD closure based on cardiac rhythms. Patients were categorized as sinus rhythm (SR group, n=89), SR after catheter ablation for atrial fibrillation (ABL group, n=14), and permanent atrial fibrillation (AF group, n=12). Echocardiography was performed at baseline, 1 day, 1 month, and 12 months after the procedure. There were significant differences in age (54.5 ± 17.5 years vs. 63.9 ± 12.6 years vs. 74.3 ± 8.4 years; p<0.01) and prevalence of moderate ≥ TR at baseline (44.9% vs. 78.6% vs. 91.7%; p<0.01) in the SR, ABL, and AF groups, respectively. The SR group showed significant improvement in TR as early as 1-day post-closure, which persisted at 12 months, whereas the ABL and AF groups exhibited no significant improvements in TR at any point post-procedure. Independent predictors of residual moderate ≥ TR at 12 months included being in the ABL or AF groups and having a higher right atrial volume index (RAVI) at baseline. In conclusion, persistent TR may remain after ASD closure, even for patients who achieve SR post-ablation and those with permanent AF. This persistence may reflect baseline atrial remodeling, as indicated by larger RAVI, beyond volume unloading after ASD closure. These findings highlight the importance of timely therapeutic interventions and careful monitoring for residual TR following ASD closure, especially in patients with a history of AF.