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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

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