Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation

Introduction Right cardiac chambers remodeling and evolution of functional tricuspid regurgitation (TR) in atrial fibrillation (AF) has been poorly assessed. Method We prospectively evaluated 117 consecutive patients hospitalized for AF with three dimensional (3D) transthoracic echocardiography at admission, 6 (6 M) and 12 months (12 M) of follow up (FU). Patients were divided into three groups according to cardiac rhythm control strategy and final rhythm at 12 M: absence/failure of restoration of SR with AF at 12 M (AF group n = 39), active restoration of SR (cardioversion, ablation) with SR at 12 M (active SR group n = 47), spontaneous restoration of SR and SR at 12 M (spontaneous SR group n = 31). Results Based on 3D echocardiography, the active SR group had at 6 M and 12 M FU a decrease of end-systolic (ES) and end-diastolic right atrial (RA) indexed volumes (Vi), and ES right ventricle (RV) Vi ( Fig. 1 B); there was also an improvement in RA emptying fraction and RV ejection fraction ( Fig. 1 E). AF group had at 12 M of FU an increase in 3D ED and ES RV Vi ( Fig. 1 A) but no modifications in 3D function ( Fig. 1 D). SR group had no modifications of Vi or function during the FU ( Fig. 1 C, F). TR vena contracta (VC) decreased significantly exclusively in the active SR group (mean of VC 0.26 ± 0.03 cm at admission versus 0.16 ± 0.03 cm after 12 M P  Conclusion Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted to improve right cardiac cavities remodelling and TR severity.