Atrial Functional Tricuspid Regurgitation: A Comprehensive Review of Pathophysiology, Diagnosis, and Management Strategies

Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, is intricately linked with atrial functional tricuspid regurgitation (AFTR), a condition distinguished from ventricular functional tricuspid regurgitation by its unique pathophysiological mechanisms and clinical implications. This review article delves into the multifaceted aspects of AFTR, exploring its epidemiology, pathophysiology, diagnostic evaluation, and management strategies. Further, we elucidate the mechanisms underlying AFTR, including tricuspid annular dilatation, right atrial enlargement, and dysfunction, which collectively contribute to the development of tricuspid regurgitation in the absence of significant pulmonary hypertension or left-sided heart disease. The section on diagnostic evaluation highlights the pivotal role of echocardiography, supplemented by cardiac magnetic resonance (CMR) imaging and computed tomography (CT), in assessing disease severity and guiding treatment decisions. Management strategies for AFTR are explored, ranging from medical therapy and rhythm control to surgical and percutaneous interventions, underscoring the importance of a tailored, multidisciplinary approach. Furthermore, the article identifies gaps in current knowledge and proposes future research directions to enhance our understanding and management of AFTR. By providing a comprehensive overview of AFTR, this review aims to raise awareness among healthcare professionals and stimulate further research to improve patient care and outcomes in this increasingly recognized condition.