Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation with Concomitant Tricuspid Regurgitation

Atrial fibrillation (AF) frequently coexists with tricuspid regurgitation (TR), a combination associated with poor clinical outcomes. Although catheter ablation improves outcomes in select AF populations, its comparative effectiveness versus antiarrhythmic drug (AAD) therapy in patients with concurrent TR remains unclear. We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults with AF and TR were stratified by treatment with catheter ablation plus AAD or AAD therapy alone. 1:1 propensity score matching was performed, yielding 13,293 patients per group. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were stroke, incident heart failure, and right heart strain. Time-to-event analyses were performed using Kaplan-Meier methods with Cox regression as sensitivity analyses. Competing-risk analyses were performed using Fine-Gray models. Over a mean follow-up of 2.60 years, catheter ablation with background AAD use was associated with a 24.8% reduction in MACE (HR 0.752 [0.701, 0.808]), along with reductions in stroke (HR 0.848 [0.788, 0.913]), heart failure (HR 0.803 [0.757, 0.852]), and right heart strain (HR 0.812 [0.761, 0.867]) compared with sole AAD therapy (all p<0.001). Findings were consistent across Cox sensitivity analyses and competing-risk models. In conclusion, among patients with AF and concomitant TR, catheter ablation with background AAD therapy was associated with lower risks of cardiovascular outcomes and survival compared with sole AAD therapy. These findings support catheter ablation as a favorable rhythm-control strategy in this high-risk population.