Recent research highlights the necessity of rhythm control in FAMR (atrial functional mitral regurgitation) for patients with heart failure with preserved ejection fraction (HFpEF). While mitral regurgitation often accompanies heart failure, atrial fibrillation (AF) significantly complicates the clinical trajectory. Researchers analyzed 218 patients to see how AF affects regurgitation severity and outcomes. Their findings underscore a vital shift in how clinicians should manage these comorbid conditions.

The Impact of AF on Regurgitation Severity

The study revealed a stark contrast between patients in sinus rhythm and those with AF. Specifically, moderate FAMR occurred in 53.3% of AF patients but only 24.5% of those in sinus rhythm. Furthermore, severe FAMR was nearly twice as common in the AF group. Consequently, atrial fibrillation seems to drive significant valve dysfunction within the HFpEF population by promoting atrial remodeling and annular dilation.

Prognostic Significance for HFpEF Patients

Clinical outcomes significantly worsened for AF patients with severe FAMR. These individuals faced a 4.1-fold higher risk of heart failure hospitalization. Moreover, the risk for the composite endpoint, including cardiovascular death, rose by 2.6 times. In contrast, regurgitation severity did not significantly predict outcomes for patients maintaining a normal sinus rhythm. These data suggest that the combination of AF and FAMR creates a high-risk phenotype that requires targeted intervention.

The Importance of Rhythm Control in FAMR

Clinicians should therefore prioritize rhythm control in FAMR as a core pathogenetic strategy. Restoring sinus rhythm may halt left atrial remodeling and reverse annular dilation. This approach could significantly lower the heavy burden of hospitalizations observed in this patient category. Overall, managing the underlying arrhythmia is just as important as treating the heart failure symptoms themselves to improve long-term survival.

FAQ

What is Functional Atrial Mitral Regurgitation (FAMR)?

FAMR is a type of heart valve dysfunction where the mitral valve leaks due to atrial enlargement and annular dilation. It typically occurs in patients with atrial fibrillation despite having a preserved left ventricular ejection fraction.

Why is rhythm control critical for HFpEF patients with FAMR?

Maintaining sinus rhythm helps reduce the severity of mitral regurgitation. Research shows it specifically lowers the risk of heart failure rehospitalization, which is significantly elevated when AF and severe regurgitation coexist.

Disclaimer: This content is for informational and educational purposes only. It is not intended as medical advice or a substitute for professional healthcare. Always consult a qualified physician for diagnosis and treatment. Refer to the latest local and national guidelines for clinical practice.

References

1. Safarova AF et al. The Value of Rhythm Control in Atrial Functional Mitral Regurgitation Among Patients With Preserved Left Ventricular Ejection Fraction. Kardiologiia. 2026 Feb 11. doi: 10.18087/cardio.2026.1.n3033. PMID: 41671019.


2. Choi HM et al. Influence of Rhythm Control on Functional Mitral and Tricuspid Regurgitation Severity and Clinical Outcome in Patients With Atrial Fibrillation: A Propensity-Matched Cohort Study. Korean Circ J. 2025;55(7). doi: 10.4070/kcj.2025.0041.


3. Reddy YN, Borlaug BA, Gersh BJ. Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction. Circulation. 2022;146(4):339-357. doi: 10.1161/CIRCULATIONAHA.122.059272.