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Atrial fibrillation complicating the course of degenerative mitral regurgitation

Determinants and long-term outcome

Francesco Grigioni, MD^*, Jean-François Avierinos, MD^*, Lieng H. Ling, MBBS, MRCP^*, Christopher G. Scott, MS, Kent R. Bailey, PhD, A. Jamil Tajik, MD, FACC^*, Robert L. Frye, MD, FACC^* and Maurice Enriquez-Sarano, MD, FACC^*,*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA and the
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

View larger version (15K): [in a new window]   Figure 1 Incidence of atrial fibrillation (AFib) under conservative (medical) management among patients with mitral regurgitation due to flail leaflets diagnosed with the patient in sinus rhythm. The overall rates of new atrial fibrillation and of permanent and paroxysmal atrial fibrillation are presented as Kaplan-Meier curves.

View larger version (13K): [in a new window]   Figure 2 Atrial fibrillation (AFib) rate in patients with mitral regurgitation due to flail leaflets diagnosed with the patient in sinus rhythm, according to age at diagnosis, <65 or 65 years old (yo). Note the considerably higher rate in older patients.

View larger version (12K): [in a new window]   Figure 3 Atrial fibrillation (AFib) rate in patients with mitral regurgitation due to flail leaflets diagnosed with the patient in sinus rhythm, according to left atrial diameter at diagnosis <50 or 50 mm. Note the considerably higher rate in patients with a markedly dilated left atrium.

View larger version (11K): [in a new window]   Figure 4 Survival of patients with mitral regurgitation due to flail leaflets adjusted for age, gender, ejection fraction and symptoms at baseline, and separating at the fourth year after diagnosis those patients with and those without postdiagnosis atrial fibrillation. Note the excess mortality in patients with follow-up atrial fibrillation. SR = sinus rhythm; AF = atrial fibrillation; F-U = follow-up.