Impact of atrial fibrillation on immediate and long-term results of mitral balloon valvuloplasty in 531 consecutive patients.
OBJECTIVE
Conflicting evidence exists regarding the impact of atrial fibrillation (AF) on the immediate and long-term outcome of mitral balloon valvuloplasty (MBV). The study aim was to investigate such outcome in 531 consecutive patients.


METHODS
The immediate and long-term (up to 18 years) clinical and echocardiographic results of MBV of 71 patients with AF at baseline were prospectively collected and compared with those of 460 patients in normal sinus rhythm (NSR).


RESULTS
Typically, patients in AF were older (42 +/- 12 years versus 30 +/- 10 years; p <0.0001) and had higher echocardiographic scores (8.45 +/- 1.14 versus 7.95 +/- 1.0; p = 0.005) than those in NSR. In patients with AF, MBV resulted in inferior immediate and long-term results, as reflected by a smaller immediate mitral valve area (MVA) (1.89 +/- 0.23 versus 2.0 +/- 0.3 cm2; p = 0.005), smaller MVA at follow up (1.49 +/- 0.39 versus 1.6 +/- 0.4 cm2; p = 0.037), and a higher restenosis rate (44% versus 30%; p = 0.012). Actuarial freedom from restenosis at 10 years was 67 +/- 6% for AF patients versus 77 +/- 2% for NSR patients (p = 0.11); values at 15 years were 34 +/- 8% and 46 +/- 4%, respectively (p = 0.18). An echo score >8 (p < 0.0001) and previous surgery (p = 0.043) were identified as predictors of restenosis. Actuarial survival at 15 years was lower in AF patients (72 +/- 11% versus 96 +/- 1%; p = 0.029). Likewise, event-free survival was lower in AF patients after 10 years (72 +/- 1% versus 89 +/- 1%; p <0.0001) and 15 years (40 +/- 9% versus 55 +/- 4%; p = 0.128). An echocardiography score > 8 (p < 0.0001) and baseline AF (p = 0.03) were identified as predictors of combined events (p < 0.0001) at follow up.


CONCLUSIONS
AF has a negative impact on the immediate and long-term outcome after MBV. In addition, the presence of AF is a marker of clinical and morphological features associated with inferior results after MBV.
Fawzy
Mohamed Eid
ME
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. fawzy100@hotmail.com
Shoukri
Mohamed
M
Osman
Adil
A
El Amraoui
Souad
S
Shah
Shabir
S
Nowayhed
Omar
O
Canver
Charles
C
D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002404:Catheterization; D015897:Comorbidity; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome