Atrial functional mitral regurgitation (AFMR) is a condition characterized by the enlargement of the left atrium and/or mitral annulus, leading to MR without intrinsic valvular disease or left ventricular dysfunction. The treatment options for AFMR can be categorized into medical therapy, surgical interventions, and transcatheter procedures.

Medical Therapy: The primary goal of medical therapy is to manage the underlying conditions contributing to AFMR, such as atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Standard heart failure therapy, including diuretics, can be used to manage symptoms. Beta-blockers and ACE inhibitors may also be prescribed to reduce the workload on the heart. However, there is no consensus on the optimal medical management for AFMR.

Surgical Interventions: Surgical options for AFMR typically involve mitral valve annuloplasty (MVA), which aims to reduce the size of the mitral annulus and improve valve function.
Studies have shown that MVA can be effective in reducing MR and improving prognosis in patients with AFMR. Other surgical options include patch augmentation of the posterior mitral leaflet and mitral valve replacement. However, the role of surgical intervention in AFMR is still under debate, and outcomes data are limited.

Transcatheter Procedures: Transcatheter edge-to-edge repair (TEER) and direct or indirect annuloplasty are emerging options for the treatment of AFMR. TEER involves the use of a device to clip the mitral leaflets together, reducing MR.
Annuloplasty can be performed using a transcatheter approach to reduce the size of the mitral annulus.
These procedures offer a less invasive alternative to surgery, but long-term outcomes data are still needed. In conclusion, the treatment of AFMR involves a combination of medical therapy, surgical interventions, and transcatheter procedures. The choice of treatment depends on the individual patient's condition, symptoms, and risk factors.