Heart Rhythm. 2025 Oct 31:S1547-5271(25)03031-0. doi: 10.1016/j.hrthm.2025.10.050. Online ahead of print.
ABSTRACT
BACKGROUND: Atrial functional mitral regurgitation (AFMR) frequently occurs secondary to atrial fibrillation (AF). Although prior studies reported improvement in AFMR severity after catheter ablation (CA), the long-term cardiovascular benefit remains uncertain.
OBJECTIVE: To evaluate the association between CA and cardiovascular outcomes in AF patients with moderate or severe AFMR.
METHODS: AF patients with moderate or greater AFMR were consecutively recruited from the China-AF registry and assigned to CA or medical therapy (MT) based on baseline treatment, following the intention-to-treat principle. This study explicitly emulated a parallel-group, randomized target trial, with follow-up aligned to treatment initiation. Baseline covariates were balanced using stabilized inverse probability of treatment weighting.
RESULTS: Among 873 patients (484 CA, 389 MT) with median follow-up of 1,509 days, 22 primary outcome events occurred in CA and 42 in MT (incidence per 100 person-years: 1.76 vs 3.30; absolute risk difference -1.54%; weighted HR 0.55 [95% CI 0.32-0.94]). CA was associated with lower weighted hazards for AF recurrence (HR 0.31; 95% CI, 0.25-0.37), cardiovascular death (HR 0.48; 95% CI, 0.24-0.96), and all-cause death (HR 0.49; 95% CI, 0.27-0.89). No significant differences were observed for ischemic stroke/systemic embolism, major bleeding, or cardiovascular hospitalization. Sensitivity analyses and exploratory subgroups showed consistent directional trends.
CONCLUSION: In AF patients with moderate or severe AFMR, CA was associated with fewer cardiovascular events in this observational study explicitly emulating a target trial, and these findings require confirmation in randomized controlled trials.
PMID:41177316 | DOI:10.1016/j.hrthm.2025.10.050