title: Evaluation of atrial refractoriness immediately after percutaneous mitral balloon commissurotomy in patients with mitral stenosis and sinus rhythm.
abstract: BACKGROUND
  Chronic atrial stretch and rheumatic inflammatory activity leads to atrial dilatation and conduction slowing, and this increases the susceptibility to atrial fibrillation (AF). The aim of this study was to examine the effects of changes in the chronic atrial stretch on atrial refractoriness in the early period after percutaneous mitral balloon commissurotomy (PMBC) in patients with mitral stenosis and sinus rhythm.
  
  
  METHODS
  Twenty-five patients undergoing PMBC were enrolled in this study. We evaluated the changes in pulmonary arterial pressure (PAP), left atrial (LA) pressure, mean mitral diastolic gradient, and mitral valve area in addition to the changes in atrial effective refractory periods (AERPs), AERP dispersion, and intra-atrial and interatrial conduction times after PMBC.
  
  
  RESULTS
  There were significant decreases in mean diastolic gradient, PAP, mean LA pressure, and LA size after PMBC. Accompanying these acute hemodynamic changes after PMBC, AERPs in high right atrium (HRA), distal coronary sinus (DCS), and right posterolateral (RPL) were found to be increased (P <.001), and AERP dispersion, PA(HIS) (an interval between P wave on the surface electrocardiogram and atrial electrogram at the His bundle site), and HRA-DCS intervals were significantly reduced after PMBC (P <.001). It was revealed with linear regression and correlation analysis that only the changes in AERP dispersion were correlated with changes in LA pressure.
  
  
  CONCLUSIONS
  Relief of chronic atrial stretch results in an increase in AERPs and decrease in AERP dispersion, suggesting the potential reversibility of the electrophysiological features of chronic atrial dilatation. Our study emphasizes that an acute reduction of chronic atrial stretch in mitral stenosis resulted in favorable effects on atrial electrophysiological characteristics, and our results provide the first detailed insights into the electrophysiological changes after PMBC in patients with sinus rhythm.
authors.affiliation: Department of Cardiology, Yüksek Ihtisas Hospital, Ankara, Turkey. sozbal@ixir.com
authors.forename: Mustafa
authors.initials: M
authors.lastname: Soylu
authors.forename: Ahmet Duran
authors.initials: AD
authors.lastname: Demir
authors.forename: Ozcan
authors.initials: O
authors.lastname: Ozdemir
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloğlu
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.forename: Erdal
authors.initials: E
authors.lastname: Duru
authors.forename: Ali
authors.initials: A
authors.lastname: Saşmaz
authors.forename: Sule
authors.initials: S
authors.lastname: Korkmaz
mesh_terms: D000328:Adult; D016279:Atrial Function, Left; D002404:Catheterization; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D016014:Linear Models; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D014463:Ultrasonography