Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease

Background: Patients with atrial fibrillation (AF) without structural heart diseases can show severe tricuspid regurgitation (TR), especially among aged people. The aim of this study was to clarify the actual management, prognosis, and prognostic factors for severe isolated TR associated with AF without structural heart diseases. Methods and results: We retrospectively investigated actual management in 178 consecutive patients with severe isolated TR associated with AF between 1999 and 2011 in our institution. Prognosis and its predictors were also investigated in 115 patients (68 persistent TR and 47 transient TR) who were followed-up for >1 year. During the follow-up period (mean: 5.9 years), event free rate from death due to right-sided heart failure (RHF) was 97% at 5 years. Persistent TR was associated with higher risk of hospitalization due to RHF than transient TR (log-rank P = 0.048) and death due to RHF were all seen in patients with persistent TR who experienced hospitalization due to RHF. Among patients with persistent TR, right ventricular outflow tract dimension >35.3 mm, right atrial area >40.3 cm(2), and tenting height >2.1mm were associated with higher risk of hospitalization due to RHF (adjusted hazard ratio: 3.32, 3.83, and 2.89, respectively; P = 0.003, 0.002, and 0.009, respectively). Conclusion: The prognosis of severe isolated TR associated with AF was good with a focus on cardiac death. However, the incidence of cardiac death increased among patients who experienced hospitalization due to RHF. Larger right ventricular outflow tract dimension, right atrial area and tenting height were predictors of hospitalization due to RHF. (C) 2017 Elsevier B.V. All rights reserved.