Balloon mitral commissurotomy for patients with mitral stenosis in atrial fibrillation: ten-year clinical and echocardiographic actuarial results.
OBJECTIVE
Controversy persists as to whether atrial fibrillation (AF) has a direct negative effect on the outcome of percutaneous balloon mitral commissurotomy (PBMC). The study aim was to assess the effect of AF on immediate and 10-year clinical and echocardiographic actuarial results of patients with rheumatic mitral stenosis undergoing PBMC.


METHODS
A total of 195 consecutive patients with AF (group 1) was analyzed and compared with 195 patients in sinus rhythm (group 2), matched for the severity of mitral valve morphological changes.


RESULTS
Group 1 patients were older (43.8 + 12 versus 30.5 +/- 12.7 years; p <0.001), and a greater proportion had grade 1 mitral regurgitation (25.1 versus 9.7%; p <0.0001). The procedural success was 89.8% in group 1 and 92.3% in group 2 (p = NS), but group 1 patients had a smaller mitral valve area (2.1 +/- 0.4 versus 2.3 +/- 0.4 cm2; p <0.0001). Patients in AF had a lower 10-year survival (91.4 versus 99.4%; p = 0.018), a lower 10-year event-free-survival (60.3 versus 70%; p = 0.02), and a lower 10-year freedom from restenosis (40 versus 66%; p = 0.048). AF was an independent predictor of overall mortality (OR = 10.79; p <0.033) and of combined events (death, redo PBMC or mitral valve surgery; OR = 1.95; p <0.012), and was a univariate predictor of restenosis (p = 0.048).


CONCLUSIONS
Patients with AF have good immediate results, but poorer long-term outcome after PBMC. AF a marker of worse prognosis in patients with mitral stenosis as it is in the general population.
Maatouk
Faouzi
F
Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. m.Maatouk@rns.tn
Betbout
Fethi
F
Ben-Farhat
Mohamed
M
Addad
Faouzi
F
Gamra
Habib
H
Ben-Hamda
Khaldoun
K
Dridi
Zohra
Z
Merchaoui
Najet
N
Hammami
Sonia
S
Maaoui
Sabri
S
Hendiri
Taoufik
T
Boughanmi
Hatem
H
D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D002404:Catheterization; D018572:Disease-Free Survival; D004452:Echocardiography; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D012214:Rheumatic Heart Disease / Q000150:complications