Atrial fibrillation in patients with pure isolated severe rheumatic mitral regurgitation

Abstract

Objective: This study examines the significance of the parameters that identify patients with mitral regurgitation (MR) and atrial fibrillation (AF) and discusses the indications for surgery in such patients.

Methods: Patients with MR and chronic AF (group I, n=64) and those without AF (group II, n=138) were studied by clinical and echocardiographic methods. Stepwise regression analysis identified factors associated with the presence of atrial fibrillation.

Results: Group I patients were older and more symptomatic. They had larger left ventricular (LV) end systolic dimension (4.6+/-1.1 cm vs 3.8+/-0.8 cm, p=0.03), left atrial (LA) dimension (5.4+/-2.0 cm vs 4.1+/-1.3 cm, p=0.02), LA area (55.9+/-27.1 cm2 vs 35.9+/-17.5 cm, p=0.003) and lower LV ejection fraction (58.8+/-8.0% vs 72.4+/-7.4%, p=0.0003). Right ventricular systolic pressure was higher (57.6+/-18.1 mm Hg vs 33.6+/-12.1 mm Hg, p=0.02). By stepwise regression analysis, factors that predicted the presence of AF were age (p < 0.03) and LA dimension (p < 0.01). A higher LV end systolic dimension and lower LV ejection fraction than the recommended value for good operative outcome were present in them. Emerging indications for surgery and predictors of poor outcome were seen.

Conclusions: Atrial fibrillation in MR indicates a more chronic and severe disease process with worsening of left as well as right sided haemodynamics in spite of digoxin. Drifting towards decompensation, these patients are likely candidates for early surgery.