title: Permanent lone atrial fibrillation and atrioventricular valve regurgitation: may the former lead to the latter?
abstract: OBJECTIVE
  Atrioventricular valve regurgitation (AVVR) has been described in patients with long-standing atrial fibrillation (AF) despite normal valve anatomy and leaflet mobility. The study aim was to examine the association between permanent lone AF and AVVR.
  
  
  METHODS
  A total of 47 patients with lone AF was studied. Patients provided information regarding the time since onset of arrhythmia, and mitral regurgitation (MR) and tricuspid regurgitation (TR) were graded using color-mapping Doppler echocardiography. AVVR was defined as any degree of valve regurgitation. Annular diameters (in mm) and atrial areas (in cm2) were measured at enddiastole, using digital analysis.
  
  
  RESULTS
  Of the 47 patients, 19 (40%) had paroxysmal AF and 28 (60%) had permanent AF. Mild MR was present in nine of 19 patients (47%) with paroxysmal AF and in 15 of 28 (53%) with permanent AF (p = 0.68). Mild TR was identified in nine (47%) patients with paroxysmal AF, and in 16 (58%) of those with permanent AF (p = 0.08). None of the patients with paroxysmal AF had either moderate or severe AVVR. In 28 patients with permanent lone AF, significant MR and TR were detected in six (21%) and five (19%) patients, respectively. Patients with permanent lone AF had a 6.5-fold higher likelihood of having TR (p = 0.0031) and were marginally more likely to have MR (p = 0.053) compared to those with paroxysmal AF. Relative to patients with paroxysmal AF, those with permanent AF had larger atrial areas and annular diameters, while patients with TR had higher atrial areas and mitral annular diameters than those without. The mean follow up of patients with permanent AF and significant AVVR was 54 + 13 months, compared to 13 +/- 7 months for those without significant AVVR (p = 0.002).
  
  
  CONCLUSIONS
  Permanent lone AF is associated with TR and, less strongly, with MR. Atrial size and mitral annular diameter are increased in patients with lone AF who have TR.
authors: Michal
authors: M
authors: Oren
authors: Ohad
authors: O
authors: Oren
authors: Alexander
authors: A
authors: Feldman
authors: Lev
authors: L
authors: Bloch
authors: Yoav
authors: Y
authors: Turgeman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology; D064752:Atrial Remodeling; D018618:Echocardiography, Doppler, Color; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007557:Israel; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013223:Statistics as Topic; D013995:Time; D014261:Tricuspid Valve / Q000473:pathology / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology