EDITORIAL
The value of rhythm control in mitral stenosis
Correspondence to:
Correspondence to:
Dr Ganesan Karthikeyan
Room 22, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India – 110029; karthik2010@gmail.com
The haemodynamic consequences of atrial fibrillation in patients with mitral stenosis have received little attention despite their clinical significance. What role does rhythm control have in the treatment of these patients?
Abbreviations: AF, atrial fibrillation; LA, left atrial; MS, mitral stenosis; PTMC, percutaneous transvenous mitral commissurotomy; SR, sinus rhythm
Keywords: mitral stenosis; atrial fibrillation; atrial contribution; ventricular filling; percutaneous mitral valvotomy
| The first 150 words of the full text of this article appear below. |
It is well recognised that patients with mitral stenosis (MS) and atrial fibrillation (AF) face a substantial risk of systemic thromboembolism. Anticoagulation with vitamin K antagonists partially offsets this risk.1 However, because of our preoccupation with non-valvular AF, the haemodynamic consequences of AF in patients with MS2 have received little attention in recent times. The article by Hu and colleagues,3 in this issue of Heart, presents an opportunity to review the value of sinus rhythm (SR) in the haemodynamics of MS.
Clinical deterioration with the onset of AF occurs because of the loss of atrial contraction and increase in heart rate, resulting in reduced cardiac output and functional capacity.2 Symptom status, exercise capacity and quality of life all improve with conversion to SR.2,4 While the detrimental effects of the reduction in diastolic filling time with increase in heart rate are well understood, the role of the loss of atrial
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