Valvular Heart DiseaseTransient, Subclinical Atrial Fibrillation and Risk of Systemic Embolism in Patients With Rheumatic Mitral Stenosis in Sinus Rhythm
Section snippets
Methods
This was a single-center, prospective, observational study of patients with pure or dominant rheumatic MS in SR. Patients attending the cardiology outpatient clinics at a tertiary care teaching hospital were assessed for eligibility. Patients were approached for enrollment if they were ≥18 years of age and had rheumatic MS (mitral valve area [MVA] <2 cm2 on echocardiography) as an isolated or dominant lesion and were in SR. In patients with multivalve disease, MS was considered dominant if it
Results
From January to December 2012, we screened 256 patients with clinically diagnosed MS for possible enrollment. We excluded 23 patients after initial evaluation and echocardiography (Figure 1). At the screening interview, 54 of the remaining 233 eligible patients indicated their inability or reluctance to attend follow-up visits or undergo baseline Holter examinations. The remaining 179 patients were enrolled in the present study. Patients were young (mean age 32 years) and had on average been
Discussion
In this cohort of young patients with rheumatic MS in SR, we found a high rate of stroke, TIA, or non-CNS systemic embolism. Transient (<30 seconds), subclinical AF was observed on 24-hour Holter monitoring in 1/4th of these patients. After adjustment for parameters of disease severity and stasis in the left atrium, subclinical AF was associated with a fivefold increase in the risk for the primary outcome. Patients without subclinical AF had a high likelihood of freedom from systemic embolic
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (22)
Atrial Fibrillation in Valvular Heart Disease
2021, Cardiac Electrophysiology ClinicsCitation Excerpt :The extent of atrial fibrosis has been linked to the success of maintaining sinus rhythm after catheter ablation of AF. Although paroxysmal AF might be recorded in patients with MS on Holter, most of them are often persistent, suggesting substrate changes play a dominant role.26 It is likely that factors contributing to persistent AF will lead to increased fibrosis.
Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery
2019, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :However, the efficacy of AF ablation in patients with rheumatic heart disease is believed to be worse than in those undergoing degenerative MV surgery. This is because the occurrence of AF in this disease is closely associated with continuous fibrosis on the MV apparatus and an enlarged left atrium.19,27,28 However, several recent studies have reported acceptable rhythm outcomes after AF ablation in the patients with rheumatic heart disease.29,30
Valvular aspects of rheumatic heart disease
2016, The LancetCitation Excerpt :Longitudinal evaluation of echocardiographic screening programmes are needed to define the absolute benefit to cost ratio because two factors restrict its widespread use in resource-poor settings: the expense of portable equipment and the shortage of highly specialised health-care workforce. Initial studies29,30 show promising findings for echocardiographic screening programmes led by nurses, although further evaluation and refinement is needed. Rheumatic heart disease is generally progressive and results in premature morbidity and mortality.
Atrial fibrillation: In the light of new hypothesis
2016, Medical HypothesesCitation Excerpt :This leads to retrograde transmission of LA pressure to intercommunicated system (LA–PV–AC) with a threat to transudation of fluid into the lung interstitium with development of pulmonary congestion and edema. 40% of patients with MS have AF [6]. The hypothesis explains emergence of AF and its direct correlation with MS.
Predictors of Ischemic Stroke in Rheumatic Heart Disease
2015, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Patients with LA SEC have a significantly increased LA diameter compared with those without, and these patients also have a significantly increased history of arterial embolization and LA thrombus.12 A recent study from India reported a significant correlation between SEC and cardioembolism but failed to reach significance on multivariate analysis.13 Our study suggested a nonsignificant increased risk of stroke with LA clot (P = .059).
Management of rheumatic mitral stenosis
2019, The Lancet
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