Table 1.

Treatment recommendations for atrial functional mitral regurgitation

Recommendation	COR	LOE
Standard medical therapy for heart failure, including diuretics, should be performed for symptomatic patients with atrial functional MR	I	C
AF catheter ablation is reasonable for symptomatic patients with persistent AF and severe atrial functional MR if successful ablation and maintenance of sinus rhythm can be expected from the duration of AF and the left atrial size	IIa	C
Mitral valve surgery is reasonable for patients with severe atrial functional MR who are consistently symptomatic despite standard medical therapy for heart failure	IIa	C

These recommendations can be applied to patients with chronic moderate atrial functional MR if the MR is severe with worsening heart failure or with exercise stress tests. Atrial functional MR is likely to accompany secondary atrial functional TR, and concomitant tricuspid surgery should be performed in patients with both atrial functional MR and TR. AF, atrial fibrillation; COR, class of recommendation; LOE, level of evidence; TR, tricuspid regurgitation. This table is taken from the 2020 guideline for management of valvular heart disease in Japan [11]