HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leon, M. N. Articles by Palacios, I. F. Search for Related Content PubMed PubMed Citation Articles by Leon, M. N. Articles by Palacios, I. F.

CLINICAL STUDIES

Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation

Immediate and long-term results

^a Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
^b Harvard Medical School, Boston, Massachusetts, USA

Manuscript received August 20, 1998; revised manuscript received April 22, 1999, accepted June 11, 1999.

Reprint requests and correspondence: Dr. Igor F. Palacios, Director, Cardiac Catheterization Laboratories and Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114
palacios.igor{at}mgh.harvard.edu

OBJECTIVES

The purpose of this study was to examine the effect of atrial fibrillation (AF) on the immediate and long-term outcome of patients undergoing percutaneous mitral balloon valvuloplasty (PMV).

BACKGROUND

There is controversy as to whether the presence of AF has a direct negative effect on the outcome after PMV.

METHODS

The immediate procedural and the long-term clinical outcome after PMV of 355 patients with AF were prospectively collected and compared with those of 379 patients in normal sinus rhythm (NSR).

RESULTS

Patients with AF were older (62 ± 12 vs. 48 ± 14 years; p < 0.0001) and presented more frequently with New York Heart Association (NYHA) class IV (18.3% vs. 7.9%; p < 0.0001), echocardiographic score >8 (40.1% vs. 25.1%; p < 0.0001), calcified valves under fluoroscopy (32.4% vs. 18.8%, p < 0.0001) and with history of previous surgical commissurotomy (21.7% vs. 16.4%; p = 0.0002). In patients with AF, PMV resulted in inferior immediate and long-term outcomes, as reflected in a smaller post-PMV mitral valve area (1.7 ± 0.7 vs. 2 ± 0.7 cm²; p < 0.0001) and a lower event free survival (freedom of death, redo-PMV and mitral valve surgery) at a mean follow-up time of 60 months (32% vs. 61%; p < 0.0001). In the group of patients in AF, severe post-PMV mitral regurgitation (3+) (p = 0.0001), echocardiographic score >8 (p = 0.004) and pre-PMV NYHA class IV (p = 0.046) were identified as independent predictors of combined events at follow-up.

CONCLUSIONS

Patients with AF have a worse immediate and long-term outcomes after PMV. However, the presence of AF by itself does not unfavorably influence the outcome, but is a marker for clinical and morphologic features associated with inferior results after PMV.

Abbreviations and Acronyms   AF = atrial fibrillation   EBDA/BSA = effective balloon dilating area/body surface area   MVR = mitral valve replacement   NSR = normal sinus rhythm   NYHA = New York Heart Association   PMV = percutaneous mitral balloon valvuloplasty   QP/QS = pulmonary to systemic flow ratio

This article has been cited by other articles:

				C L Hu, H Jiang, Q Z Tang, Q H Zhang, J B Chen, C X Huang, and G S Li Comparison of rate control and rhythm control in patients with atrial fibrillation after percutaneous mitral balloon valvotomy: a randomised controlled study Heart, August 1, 2006; 92(8): 1096 - 1101. [Abstract] [Full Text] [PDF]

				H. Nakajima, J. Kobayashi, K. Bando, Y. Yasumura, S. Nakatani, K. Kimura, K. Niwaya, O. Tagusari, and S. Kitamura Consequence of atrial fibrillation and the risk of embolism after percutaneous mitral commissurotomy: The necessity of the maze procedure Ann. Thorac. Surg., September 1, 2004; 78(3): 800 - 805. [Abstract] [Full Text] [PDF]

				J. Langerveld, N. M. van Hemel, J. C. Kelder, J. M. P. G. Ernst, H. W. M. Plokker, and W. Jaarsma Long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy: Does atrial fibrillation persist? Europace, January 1, 2003; 5(1): 47 - 53. [Abstract] [PDF]

				I. F. Palacios, P. L. Sanchez, L. C. Harrell, A. E. Weyman, and P. C. Block Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty?: Prevalvuloplasty and Postvalvuloplasty Variables That Predict Long-Term Outcome Circulation, March 26, 2002; 105(12): 1465 - 1471. [Abstract] [Full Text] [PDF]