title: Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm.
abstract: This study evaluated the predictors of atrial fibrillation (AF) and adverse clinical events in patients with rheumatic mitral stenosis (RMS) in sinus rhythm. The patients who diagnosed with RMS in sinus rhythm were evaluated retrospectively between March 2003 and June 2013. The primary outcome was the development of new-onset AF with annual event rates and the secondary outcome was the incidence of clinical events including development of new-onset AF, systemic embolism and all-cause death during follow-up. Among 293 patients, AF developed in 60 (20.5%) patients with average annual event rate of 3.5%/year during mean follow-up period of 68.2 ± 36.6 months (median 72 months). All cause death or systemic embolism occurred in 7.2% (21 patients; all cause death 9, embolism 12) with an average annual event rate of 2.1%. In the multivariate analysis, large left atrium (LA) dimension and severe mitral stenosis (≤1.5 cm(2)) were independent predictors of AF development [HR 1.06, 95% CI: 1.02-1.10; P = 0.001, HR 1.97, 95% CI: 1.06-4.14; P = 0.032] after adjustment for confounding factors. Patients with enlarged LA (≥47 mm) had an average annual AF development rate of 6.0%/year. In patients with RMS in sinus rhythm, annual AF development rate was 3.5%/year and increased according to LA size and mitral stenosis (MS) severity. Because of very high risk embolism, RMS with enlarged LA dimension need focused follow up for early detection of AF development and clinical events.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors: Hyun-Jin
authors: HJ
authors: Kim
authors: Goo-Yeong
authors: GY
authors: Cho
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Hyung-Kwan
authors: HK
authors: Kim
authors: Seung-Pyo
authors: SP
authors: Lee
authors: Hack-Lyoung
authors: HL
authors: Kim
authors: Jin Joo
authors: JJ
authors: Park
authors: Yeonyee E
authors: YE
authors: Yoon
authors: Joo-Hee
authors: JH
authors: Zo
authors: Dae-Won
authors: DW
authors: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004617:Embolism / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors