title: Immediate and long-term results following balloon mitral valvotomy in patients with atrial fibrillation.
abstract: BACKGROUND
  The purpose of this study was to examine the influence of atrial fibrillation (AF) on the immediate and long-term outcome of patients undergoing balloon mitral valvotomy (BMV).
  
  
  OBJECTIVE
  Patients with atrial fibrillation fair poorly after balloon mitral valvotomy.
  
  
  METHODS
  There were a total of 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, with either double-lumen or triple-lumen BMV catheters included in the study. Of them, 95 were with AF. The clinical, echocardiographic, and hemodynamic data of these patients were compared with those of 723 patients in normal sinus rhythm (NSR). Immediate procedural results and long-term events were compared between the 2 study groups.
  
  
  RESULTS
  Patients with AF were older (39.9 ± 9.9 years vs 29.4 ± 10.1, P < 0.001) and presented more frequently with New York Heart Association (NYHA) class III-IV (53.7% vs 32.9%, P < 0.001), echocardiographic score >8 (47.4% vs 24.9%, P < 0.001), and with history of previous surgical commissurotomy (33.7% vs 11.5%, P < 0.001). In patients with AF, BMV resulted in inferior immediate and long-term outcomes, as reflected in a lesser post-BMV mitral valve area (1.3 ± 0.4 vs 1.6 ± 0.4 cm(2), P = 0.032) and higher event rate on follow-up.
  
  
  CONCLUSIONS
  Patients with AF were older, sicker, and had advanced rheumatic mitral valve disease. They had a higher incidence of stroke, new onset heart failure, and need for reinterventions on long-term follow-up. These patients need intense and more frequent follow-up.
authors.affiliation: Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Krishna Kumar Mohanan
authors.initials: KK
authors.lastname: Nair
authors.forename: Harikrishnan Sivadasan
authors.initials: HS
authors.lastname: Pillai
authors.forename: Anees
authors.initials: A
authors.lastname: Thajudeen
authors.forename: Kavassery Mahadevan
authors.initials: KM
authors.lastname: Krishnamoorthy
authors.forename: Sivasankaran
authors.initials: S
authors.lastname: Sivasubramonian
authors.forename: Narayanan
authors.initials: N
authors.lastname: Namboodiri
authors.forename: Bijulal
authors.initials: B
authors.lastname: Sasidharan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Ganapathy
authors.forename: Ajitkumar
authors.initials: A
authors.lastname: Varaparambil
authors.forename: Thomas
authors.initials: T
authors.lastname: Titus
authors.forename: Jaganmohan
authors.initials: J
authors.lastname: Tharakan
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors