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Closely linked to chronic atrial fibrillation and heart failure with preserved ejection fraction, AFMR is associated with poor clinical outcomes and represents a growing therapeutic challenge. This expert opinion paper summarizes current evidence on the epidemiology, pathophysiology, diagnosis and management strategies, including medical therapy and emerging data supporting surgical and transcatheter interventions in selected patients. However, data from prospective controlled clinical trials are still lacking. Future research is needed to refine patient selection, long-term outcomes and to support evidence-based recommendations for this increasingly prevalent condition.<\/jats:p>","DOI":"10.1002\/ehf2.15405","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:08:01Z","timestamp":1757498881000},"page":"3788-3805","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Epidemiology, Pathophysiology, Diagnosis and Management of Atrial Functional Mitral Regurgitation: An Expert Opinion Paper"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-7871","authenticated-orcid":false,"given":"Matteo","family":"Pagnesi","sequence":"first","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Institue of Cardiology, ASST Cremona , Cremona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, San Raffaele Scientific Institute , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Grapsa","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassilis","family":"Barberis","sequence":"additional","affiliation":[{"name":"American Medical Center, American Heart Institute , Nicosia ,","place":["Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdy","family":"Abdelhamid","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University , Giza ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Laura","family":"Antohi","sequence":"additional","affiliation":[{"name":"Emergency Institute for Cardiovascular Diseases \u2018Prof. C.C. Iliescu\u2019 , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrike","family":"Arfsten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Karam","sequence":"additional","affiliation":[{"name":"Cardiology Department, Clemenceau Medical Center, Balamand University , Beirut ,","place":["Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa","family":"Muraru","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Department of Medicine and Surgery, University of Milano-Bicocca, Department of Cardiolog, Istituto Auxologico Italiano, IRCCS , Milan 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