Background:Mitral regurgitation is frequently complicated with atrial fibrillation without apparent organic changes in the leaflet, which occasionally improves after successful radiofrequency catheter ablation. We aimed to evaluate a possible geometric effect of radiofrequency catheter ablation on the mitral valve apparatus.Methods:Forty-three consecutive patients who underwent successful catheter ablation for persistent atrial fibrillation (maintaining sinus rhythm for 6 months after their procedure) were examined by serial real-time 3-dimensional transesophageal echocardiography before and 6 months after catheter ablation. Mitral valve complex geometry was measured using dedicated software for 3-dimensional transesophageal echocardiography.Results:Mitral valve apparatus showed significant reverse remodeling along with left atrial reverse remodeling 6 months after successful catheter ablation (50.5 [39.2–61.0] versus 36.4 [28.9–43.1] mL/m²; P<0.001). The degree of mitral regurgitation decreased in a majority of patients (mitral regurgitation jet area; 1.83 [0.78–3.09] versus 0.77 [0.36–1.47] cm²; P<0.001). Annular area significantly decreased (5.32±0.91 versus 4.73±0.76 cm²/m²; P<0.001) in both anterior-posterior and medial-lateral directions. Mitral annular contraction significantly recovered after maintaining sinus rhythm for 6 months (7.51 [4.82–9.62]% versus 9.71 [6.27–13.85]%; P=0.008). There were no significant changes in tenting volume or tenting height (0.46 [0.27–0.89] versus 0.51 [0.32–0.72] mL/m², P=0.744; 2.34 [1.75–3.48] versus 2.76 [1.99–3.08] mm/m², P=0.717). The leaflet surface area also significantly decreased after catheter ablation (5.74 [5.01–6.33] versus 5.19 [4.63–5.64] cm²/m²; P<0.001).Conclusions:Maintaining sinus rhythm after successful catheter ablation promotes reverse remodeling in the mitral valve apparatus and improves so-called atrial functional mitral regurgitation. The positive geometric effect of catheter ablation would be expected to be a possible contributor to better outcomes in patients with atrial fibrillation, in addition to the postprocedural freedom from rhythm disturbance.

中文翻译：

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房颤射频消融后二尖瓣复合体的逆向重构：连续3维超声心动图研究。

背景：二尖瓣关闭不全经常伴有房颤，小叶中没有明显的器质性改变，在射频导管成功消融后偶尔会改善。我们的目的是评估射频导管消融对二尖瓣装置可能产生的几何影响。方法：连续进行了43例因持续性房颤成功行导管消融术（术后6个月保持窦性心律）的连续患者。消融前和消融后6个月进行3次经食管超声心动图检查。使用专用的3维经食道超声心动图软件测量二尖瓣复杂的几何形状。² ; P <0.001）。在大多数患者中，二尖瓣反流程度降低（二尖瓣反流射流面积； 1.83 [0.78-3.09] cm ²和0.77 [0.36-1.47] cm ²；P <0.001）。在前后方向和内侧方向上，环形面积均显着减小（5.32±0.91对4.73±0.76 cm ² / m ²；P <0.001）。维持窦性心律6个月后，二尖瓣环收缩明显恢复（7.51 [4.82-9.62]％对9.71 [6.27-13.85]％；P = 0.008）。帐篷体积或帐篷高度没有明显变化（0.46 [0.27-0.89]对0.51 [0.32-0.72] mL / m ²，P= 0.744；2.34 [1.75-3.48]和2.76 [1.99-3.08] mm / m ²，P = 0.717）。导管消融后小叶表面积也显着减少（5.74 [5.01-6.33] vs 5.19 [4.63-5.64] cm ² / m ²；P <0.001）。结论：成功消融导管后维持窦性心律可促进二尖瓣逆向重塑。瓣膜装置并改善所谓的心房功能性二尖瓣反流。导管消融的积极几何效应有望为心房颤动患者带来更好的预后，而且在手术后不受节律紊乱的影响。