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Atrial Functional TR Reversibility — EECC MCQ

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ModerateValvular Heart DiseaseAtrial Functional TR ReversibilityEECC

A 70-year-old woman with moderate TR secondary to AF undergoes catheter ablation and successful restoration of sinus rhythm. Six months later, her TR has improved from severe to mild. What does this demonstrate?

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Correct answer: A — Atrial functional TR can be reversible when the underlying cause (AF-related atrial and annular dilatation) is treated; this supports early rhythm control to prevent irreversible annular remodelling

Atrial functional TR (AFTR) is a relatively recently recognised entity distinct from ventricular functional TR. AFTR is caused by: RA and tricuspid annular dilatation from chronic AF, without significant RV or LV dysfunction. Importantly, AFTR may be reversible if AF is successfully treated (cardioversion, ablation) before irreversible annular remodelling occurs. The 2025 ESC VHD Guidelines recognise AFTR as a distinct pathophysiological mechanism. This case illustrates that early rhythm control in AF may prevent progression to irreversible severe TR requiring intervention. If AF persists and annular dilatation becomes chronic, the tricuspid annulus loses its contractile saddle-shaped anatomy and TR becomes irreversible.

Reference: ESC/EACTS (2025): VHD Guidelines; ESC (2024): AF Guidelines