Effects of late regain of sinus rhythm on pulmonary artery pressure and functional status in patients with mitral valve replacement surgery and atrial fibrillation.
OBJECTIVE
The study aim was to evaluate the effects of regaining sinus rhythm (SR) on pulmonary artery pressure (PAP) and NYHA class in patients undergoing mitral valve replacement (MVR) surgery and in atrial fibrillation (AF).


METHODS
Forty patients (mean age 50.7+/-8.2 years) with previous MVRS and chronic AF were included in the study; the mean postoperative interval was 54.7+/-31.8 months. Among these 40 patients, 22 (the study group) were treated with amiodarone (600 mg/day) and direct current (DC) cardioversion (CV), while 18 (control group) underwent normal treatment.


RESULTS
In the study group, two patients regained SR with amiodarone loading, while 20 proceeded with DC CV at 21 days after amiodarone loading. SR was regained in 20 patients. The amiodarone dosage was lowered to 200 mg/day in the sixth postoperative week. Patients were followed for a mean of 18.0+/-4.4 months (range: 12-22 months). In the study group, recurrence of AF occurred in only one patient, at four months after DC CV. SR was maintained in 19 patients. At a clinical control examination, the mean NYHA class of study patients was decreased from 2.6+/-0.5 to 1.8+/-0.6 in two months, and to 1.5+/-0.6 in 12 months (p <0.01). Doppler echocardiographic follow up in the study group showed PAP to be significantly reduced, from 44.2+/-12.3 mmHg to 32.8+/-8.1 mmHg (p <0.01).


CONCLUSIONS
In patients with MVR and AF, amiodarone treatment and DC CV achieved good early and mid-term success in regaining and maintaining SR. Regulation of rhythm was concomitant with a reduction in PAP and improved NYHA functional class. Hence, a special effort should be made to correct arrhythmia in patients with MVR and AF.
Kabukcu
Mehmet
M
Akdeniz University, School of Medicine, Cardiology and Cardio-thoracic Surgery Department, Antalya, Turkey. kabukcu@akdeniz.edu.tr
Yanik
Ekrem
E
Demircioglu
Fatih
F
Gölbasi
Ilhan
I
Ersel
Filiz
F
D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone