Catheter Ablation or Surgical Therapy in Severe Atrial Functional Mitral Regurgitation Caused by Long‐Standing Persistent Atrial Fibrillation—Propensity Score Analysis

Background There is no consensus on the treatment strategy for patients with severe atrial functional mitral regurgitation combined with heart failure (HF), with a lack of comparative studies in patients with long‐standing persistent atrial fibrillation and severe atrial functional mitral regurgitation. We aim to compare mitral valve repair combined with the maze procedure with catheter ablation in patients with severe atrial functional mitral regurgitation due to long‐standing persistent atrial fibrillation. Methods and Results Patients with severe atrial functional mitral regurgitation and long‐standing persistent atrial fibrillation were included in this retrospective cohort study. Surgical patients underwent mitral valve repair combined with the Cox maze procedure, whereas catheter patients underwent catheter radiofrequency ablation. Mortality, atrial fibrillation recurrence, and HF readmission were assessed using overlap propensity score weighting. Then, between 2018 and 2022, we identified 302 patients: 215 in the surgical group and 87 in the catheter group. There were significant differences in the baseline characteristics between groups. The surgical group had lower rates of atrial fibrillation recurrence ( P =0.03), HF readmission ( P =0.03), and mitral regurgitation grade >2 at discharge ( P <0.01) and follow‐up ( P <0.01). However, there were no significant differences in the 5‐year freedom from death (log‐rank P =0.87), atrial fibrillation recurrence (log‐rank P =0.36), or HF readmission rates (log‐rank P =0.18). Conclusions Compared with surgical patients, the catheter group had higher atrial fibrillation recurrence and HF readmission rates; however, the difference was not significant after overlap propensity score weighting. Although the proportion of patients with significant mitral regurgitation at the last follow‐up was higher after catheter ablation, most patients still showed an effective decrease in mitral regurgitation severity.