Effect of mitral valve repair/replacement surgery on atrial arrhythmia behavior.
OBJECTIVE
Few data have been published on the effects of mitral valve surgery on atrial rhythm. The study aims were to determine the effects of surgery on: (i) persistence of atrial fibrillation (AF); (ii) measures of left atrial and ventricular dimensions; and (iii) ECG P-wave duration.


METHODS
A retrospective case-note review of 92 patients with chronic mitral regurgitation was undertaken. Variables determined included prevalence and duration of AF; incidence of new-onset or persistence of AF after surgery; rhythm changes in relation to age, gender, left atrial and ventricular dimensions and function, anti-arrhythmic drug usage and ECG P-wave duration in sinus rhythm prior to surgery.


RESULTS
Only 4/47 (8.5%) patients with any history of AF before surgery were in sinus rhythm at six months after surgery. All 28 patients with persistent AF for >12 months and 41/45 (91%) in sinus rhythm before surgery retained these rhythms after surgery. The left atrial dimension was decreased after surgery, in the whole group (51.3 +/- 9.0 versus 48.4 +/- 9.5 mm; p = 0.011) and in the subgroup in sinus rhythm, but not in the subgroup in AF. The left ventricular end-diastolic dimension decreased in the group as a whole (60.6 +/- 6.2 versus 53.0 +/- 8.7 mm; p = 0.0001) and in both subgroups after surgery. In 24 patients with 12- lead ECGs in sinus rhythm before and three months after surgery, P-wave duration remained unchanged. However, this measure decreased in the 18 patients in sinus rhythm consistently, but increased in the six patients continuing to have paroxysmal AF after surgery.


CONCLUSIONS
Mitral valve surgery alone restored sinus rhythm in only 8.5% of patients with any previous history of AF. Concomitant anti-arrhythmic procedures should be considered for all patients with AF who undergo mitral valve surgery.
Raine
Dan
D
Department of Academic Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Hospitals Trust, UK. D.T.Raine@ncl.ac.uk
Dark
John
J
Bourke
John P
JP
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D000889:Anti-Arrhythmia Agents