Feasibility and outcomes of pulmonary vein isolation after transcatheter tricuspid valve intervention in patients with atrial fibrillation
J Schipper, J Woermann, J Van Den Bruck, S Dittrich, J Ackmann, T Maximidou, I Erdmann, J Grobecker, C Iliadis, R Pfister, J Lueker, D StevenAbstract
Background
Atrial fibrillation (AF) is common in patients with heart failure with preserved ejection fraction (HFpEF) and contributes to right atrial and ventricular dilatation, functional tricuspid regurgitation (TR), and progressive right heart failure. Transcatheter tricuspid valve intervention (TTVI) effectively reduces TR; however, AF often remains clinically significant. Evidence regarding pulmonary vein isolation (PVI) in this population is limited.
Purpose
To evaluate the feasibility, safety, and rhythm outcomes of PVI in patients with AF after prior TTVI.
Methods
We retrospectively analyzed consecutive patients undergoing first-time PVI following TTVI between May 2021 and August 2025 at a single tertiary center. Procedural feasibility, acute success, complications, and maintenance of sinus rhythm (SR) during follow-up were assessed.
Results
Ten patients (mean age 76 ± 9 years; 8 [80%] female) were included. TTVI consisted of edge-to-edge repair in 6 patients, transcatheter annuloplasty in 2, and valve replacement in 1. Persistent AF was present in 8 patients (80%). Mean procedure duration was 88 ± 35 minutes. PVI was performed using thermal ablation (radiofrequency 6 [60%], cryoballoon 1 [10%]) or pulsed field ablation (3 [30%]). Additional substrate modification for low-voltage areas or atrial tachycardia was required in 3 patients (30%). Acute isolation of all pulmonary veins was achieved in all procedures. No major complications occurred. After a median follow-up of 16 months (IQR 14–22), 2 of 9 patients (22%) remained free from atrial arrhythmia.
Conclusions
PVI after TTVI is feasible and can be performed safely with contemporary ablation technologies. However, long-term rhythm control was poor, likely reflecting irreversible atrial remodeling. These findings highlight the need for individualized rhythm-control strategies in this challenging and increasingly prevalent patient population.