Echocardiographic Prediction of Symptomatic Atrial Fibrillation In Patients with Rheumatic Mitral Stenosis and Normal Sinus Rhythm

Abstract

In rheumatic mitral stenosis (RMS), mitral valve area is reduced, creating an obstruction to the blood flow between the left atrium (LA) and the left ventricle (LV), causing an elevation in LA pressure. Elevation in LA pressure has several important effects including enlargement of the LA, atrial arrhythmias, and an increase in pulmonary venous pressure. RMS increases the risk of both atrial fibrillation (AF) and thromboembolism, causing an important health care problem in developing countries. The prevalence of AF in patients with MS is between 17 to 80% and related to both the severity of valve obstruction and patient age .1 The incidence of systemic embolism is greater in rheumatic mitral valve disease than in any other common form of valvular heart disease.Patients with AF and mitral stenosis have high incidence of thrombus formation in the LA .2,3 AF is the most commonly encountered cardiac arrhythmia in this subset of patients with an increased risk of thromboembolism.4 Although mitral stenosis is considered as a strong risk factor for AF, the parameters in mitral stenosis that predict the risk of Abstract Introduction:Rheumatic mitral stenosis (RMS) increases the risk of both atrial fibrillation (AF) and thromboembolism. Methods: Patients with mitral stenosis and normal sinus rhythm were enrolled in the study prospectively.The present study was designed to study whether echocardiographic evaluation in patients with mitral stenosis and normal sinus rhythm could predict the occurrence of symptomatic AF . Results: Sixty-two patients (51 females) with mitral stenosis and normal sinus rhythm were included in the study. Seven patients (11.3%) developed symptomatic AF and the remaining 55 were free of AF during a followed-up of 22±5 months. The following echocardiographic parameters were significantly increased and predicted the development of AF; left atrial (LA) mediolateral diameter (5.5 ± 0.5 cm vs 4.7 ± 0.7 cm), right atrial mediolateral diameter (4,7 ± 1.0 cm vs 3.6 ± 1.3 cm), LA area in the apical two chamber view ( 31 ± 3.2 cm2 vs 25 ± 5.8 cm2), right atrial volume (52 ± 22 cm3 vs 34 ± 19 cm3), and interatrial conduction time (IACT) (142 ± 22 msec vs 115 ± 16 msec). Conclusions: OThis study revealed that echocardiography can be used to predict symptomatic AF in patients with RMS and sinus rhythm.

Detection of paroxysmal atrial fibrillation with Holter ECG monitoring in patients with severe rheumatic mitral stenosis in sinus rhythm at Tikur Anbessa Specialized Hospital, AAU: Prospective cross-sectional study. Principal Investigator

“…[26] The presence of severe pulmonary hypertension and a left atrial size >50 mm were identi ed as echocardiographic ndings that suggested a trend toward a higher prevalence of paroxysmal atrial brillation in this study, which was consistent with the ndings of Serdar Bicergolu in 2008. [27] However, in our study, the association was not statistically signi cant. (CI 95% P= 0.466).…”

“…In reality, there are differences between the two study designs; our cross-sectional study and the Serdars were prospective studies, which might provide them with an opportunity to track earlier who developed AF. [27] Since all patients in our study had preserved LV systolic function, it was impossible to determine whether reduced left ventricular systolic function was associated with a greater risk of paroxysmal atrial brillation in the presence of severe MS, as was the case in other studies, such as that of Moreyra et al [23] As shown in Table 6, aortic stenosis tended to be associated with the emergence of paroxysmal atrial brillation, even though this association did not reach statistical signi cance. This could be due to reduced LV compliance associated with AS leading to further atrial cardiomyopathy, which in turn acts as grounds for the development of PAF.…”