Evaluation of the Remodeling of the Tricuspid Annulus and Right Heart in Persistent Atrial Fibrillation Patients With or Without Radiofrequency Ablation via Three-Dimensional Echocardiography.

BACKGROUND: Atrial fibrillation (AF) is linked to tricuspid annulus (TA) and right heart (RH) remodeling. Despite advances in catheter ablation, data regarding its structural impact on the TA and RH chambers remain limited. Therefore, the impact of radiofrequency ablation (RFA) on TA and RH remodeling in persistent AF patients is less clear. Furthermore, the potential of three-dimensional echocardiography (3DE) for evaluating TA and RH remodeling following RFA requires further exploration. This study aimed to characterize TA and RH geometry and function in persistent AF patients before and after RFA via 3DE. METHODS: The 90 subjects included in this study were divided into three groups: the persistent AF group (n = 30); persistent AF patients who underwent successful RFA with sinus rhythm maintenance at the 3-month follow-up were assigned to the RFA group (n = 30); and the control group (n = 30). 3DE datasets were analyzed to measure TA and RH geometry and function via Tomtec 3D echocardiography analysis software. RESULTS: Compared with the AF group, the RFA group presented shorter linear dimensions of the right atrium (RA) (p < 0.05). The right atrial ejection fraction (EF) and right ventricular (RV) EF were significantly greater in the RFA group than in the AF group (RAEF: 45.56% vs. 28.57%, p = 0.003; RVEF: 45.94% vs. 38.45%, p < 0.001). However, there was no significant difference in the RV fractional area change (FAC) index (p > 0.05). The TA area, anteroposterior diameter, and circumference were significantly smaller in the RFA group than in the control group in all phases (all p < 0.05). After 3 months, RFA intervention (B = -0.440, p < 0.001) demonstrated significant inverse associations with the TA perimeter. Moreover, the non-planar angle and tricuspid leaflet tenting height were smaller in the RFA group than in the control group in the systolic phase (p < 0.05). CONCLUSIONS: This study suggests that RFA may contribute to favorable TA and RH remodeling in patients with persistent AF, and that 3DE may provide more comprehensive and sensitive assessments with excellent feasibility, facilitating readily accessible evaluations for AF patients undergoing RFA.