title: The predictive value of chronic atrial fibrillation for the short- and long-term outcome after percutaneous mitral balloon valvotomy.
abstract: OBJECTIVE
  The predictive value of chronic atrial fibrillation (AF) before percutaneous mitral balloon valvotomy (PMBV) is still under discussion. The effect of the duration of chronic AF on short- or long-term results is not known. Therefore, we analyzed the predictive value of pre-procedural chronic AF and the duration of this rhythm disturbance for short- and long-term outcome after PMBV in patients with mitral valve stenosis.
  
  
  METHODS
  A total of 140 PMBV procedures was performed in 137 patients with severe mitral stenosis. Sixty-three patients (45%) were in chronic AF; in 40 patients (63%) the AF was of more than one year duration. A successful procedure is defined as PMBV achieved without acute mitral valve replacement, and a mitral valve area after PMBV of > or =1.5 cm2.
  
  
  RESULTS
  Patients in chronic AF were significantly older, had a larger left atrial diameter and higher NYHA functional class, compared with patients in sinus rhythm (SR). The success rates of PMBV were 80.5% and 77.6% in patients with SR and AF, respectively (p = NS). Mean follow up was 4.2+/-2.6 years (n = 127). At four years' follow up the event-free survival was 86.5% in patients with SR, and 78.5% in those with chronic AF at baseline (p = 0.031). Multivariate analysis of the entire study population showed the presence of chronic AF to be the only pre-procedural independent predictor for severe mitral regurgitation after PMBV (p = 0.030), as well for an event (p = 0.039) and restenosis (p = 0.034) during follow up. The risk for an event or restenosis during follow up increased seven-fold when chronic AF at baseline was present for more than one year (p = 0.010).
  
  
  CONCLUSIONS
  Pre-procedural chronic AF is an independent predictor for unfavorable outcome at short- and long-term follow up after PMBV. A longer duration of AF further increases the risk of an event or restenosis.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Langerveld
authors.forename: N M
authors.initials: NM
authors.lastname: Hemel
authors.forename: S M
authors.initials: SM
authors.lastname: Ernst
authors.forename: H W
authors.initials: HW
authors.lastname: Plokker
authors.forename: J C
authors.initials: JC
authors.lastname: Kelder
authors.forename: W
authors.initials: W
authors.lastname: Jaarsma
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications*; D002404:Catheterization / Q000379:methods*; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology; D008946:Mitral Valve Stenosis / Q000209:etiology* / Q000628:therapy*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome