Right cardiac chambers remodeling and evolution of functional tricuspid regurgitation (TR) in atrial fibrillation (AF) has been poorly assessed.

We prospectively evaluated 117 consecutive patients hospitalized for AF with three dimensional (3D) transthoracic echocardiography at admission, 6 (6M) and 12 months (12M) of follow up (FU). Patients were divided into three groups according to cardiac rhythm control strategy and final rhythm at 12M: absence/failure of restoration of SR with AF at 12M (AF group n=39), active restoration of SR (cardioversion, ablation) with SR at 12M (active SR group n=47), spontaneous restoration of SR and SR at 12M (spontaneous SR group n=31).

Based on 3D echocardiography, the active SR group had at 6M and 12M FU a decrease of end-systolic (ES) and end-diastolic right atrial (RA) indexed volumes (Vi), and ES right ventricle (RV) Vi (Fig. 1B); there was also an improvement in RA emptying fraction and RV ejection fraction (Fig. 1E). AF group had at 12M of FU an increase in 3D ED and ES RV Vi (Fig. 1A) but no modifications in 3D function (Fig. 1D). SR group had no modifications of Vi or function during the FU (Fig. 1C, F). TR vena contracta (VC) decreased significantly exclusively in the active SR group (mean of VC 0.26±0.03cm at admission versus 0.16±0.03cm after 12M P<0.05).

Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted to improve right cardiac cavities remodelling and TR severity.