Impact of functional mitral regurgitation on outcomes of high-power short-duration pulmonary vein isolation in patients with atrial fibrillation

Background: Atrial fibrillation (AF) is a common arrhythmia with significant health implications. Mitral regurgitation (MR) frequently coexists with AF and may affect treatment outcomes. Methods: This study aimed to analyze the impact of MR severity on the outcomes of high-power short-duration pulmonary vein isolation (PVI) in patients with AF. This observational cohort study involved 255 patients undergoing their first PVI. A total of 83 patients with moderate or severe MR were propensity score-matched with 83 controls based on age, sex, and body mass index (BMI). Procedural parameters, complication rates, AF recurrence within 1 year of PVI, and MR progression were analyzed. Results: Patients with moderate or severe MR demonstrated a higher percentage of atrial low-voltage areas (23.06% vs. 15.42%, p = 0.04) and more frequently required additional ablations (18.07% vs. 6.02%, p = 0.02). The 1-year AF recurrence rates were identical between the groups (19.28% each, p = 1.00). The MR grade remained stable without significant differences between the groups after 1 year. However, among patients without AF recurrence, a statistically significant reduction in MR grade was observed after 1 year (1.54 +/- 0.64 vs. 1.37 +/- 0.53, p < 0.01). By contrast, patients with AF recurrence exhibited a trend toward worsening MR, although this change was not statistically significant (1.53 +/- 0.57 vs. 1.75 +/- 0.51, p = 0.09). Conclusion: High-power short-duration PVI is safe and effective in AF patients, even among those with moderate or severe MR. Patients with moderate or severe functional MR exhibit more LA low-voltage areas and require more extensive ablations, especially cavotricuspid isthmus CTI ablation, reflecting a more complex disease profile. Maintaining a stable sinus rhythm can contribute to a reduction in MR grade.