Grigioni F, et al. - In 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%) in the MIDA (Mitral Regurgitation International Database) registry, researchers assessed the prognostic/therapeutic implications of atrial fibrillation (AF) at degenerative mitral regurgitation (DMR) diagnosis and long-term. A total of 1,646 patients presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AF, and 462 with persistent AF. Findings revealed a frequent occurrence of AF at DMR diagnosis. They found an association of AF with older age and more severe presentation of DMR. Also, AF was found to be independently related to excess mortality long-term after diagnosis. In each cardiac rhythm subset, improved survival was observed after surgery, but excess risk persisted for each type of AF. Based on these findings, surgery should be promptly considered in the presence of AF, even paroxysmal.