Prognostic predictors of sinus rhythm control by amiodarone and electrical cardioversion in patients undergoing percutaneous transluminal mitral valvuloplasty for rheumatic atrial fibrillation.
BACKGROUND
Conversion to sinus rhythm (SR) is rarely attempted in patients with rheumatic atrial fibrillation (AF) because the length of AF duration and the dilation of left atrium (LA) make maintenance of SR difficult. In this study, predictors of the successful maintenance of SR with amiodarone and electrical cardioversion in rheumatic AF patients receiving percutaneous transluminal mitral valvuloplasty (PTMV) were identified.


RESULTS
This study included 23 consecutive patients undergoing PTMV for rheumatic AF (6 men, 53+/-11 years; AF duration 25 +/-24 months; LA diameter 44+/-6 mm; mitral valve area (MV) 1.1+/-0.2 cm(2)). Electrical cardioversion was required for the successful conversion to SR in all patients regardless of whether they had received amiodarone (400 mg/day) 2 months before PTMV (n=8) or 2 months after (n=15). After cardioversion, all patients received amiodarone 200 mg/day. With a follow-up period of 35+/-8 months, 14 patients (61%) remained in SR. A greater reduction in LA size (-4+/-3 mm vs 1+/-1 mm; p=0.004) and an greater increase in MV area (0.8+/-0.4 cm(2) vs 0.5+/-0.2 cm(2); p=0.01) by PTMV, not AF duration, were found to be the independent predictors for patients with successful maintenance of SR as compared with patients with recurrence of AF.


CONCLUSIONS
In rheumatic AF patients receiving PTMV, the successful maintenance of SR with amiodarone and electrical cardioversion can be predicted by the degree to which LA size is reduced and MV area is increased.
Guo
Gary Bih-Fang
GB
Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. garyguomd@yahoo.com.tw
Hang
Chi-Ling
CL
Chang
Hsueh-Wen
HW
Wu
Chiung-Jen
CJ
Fang
Chih-Yuan
CY
Chen
Chien-Jen
CJ
D000328:Adult; D000638:Amiodarone / Q000494:pharmacology / Q000627:therapeutic use*; D000800:Angioplasty, Balloon / Q000379:methods*; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D004554:Electric Countershock; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000628:therapy; D012849:Sinoatrial Node / Q000187:drug effects / Q000503:physiopathology*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone