title: Immediate effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and P-wave dispersion in patients with severe mitral stenosis.
abstract: BACKGROUND
  Mitral stenosis (MS) is associated with prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion, which are markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters.
  
  
  METHODS
  This single center observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm(2)), in sinus rhythm, who underwent successful PTMC at our hospital. P-wave dispersion (PWD) was calculated by subtracting minimum P-wave duration (P min) from maximum P-wave duration (Pmax), measured on a 12-lead surface ECG obtained from each patient in supine position at a paper speed of 50mm/s and 20mm/mV. Inter-atrial (AEMD), left intra-atrial (L-IAEMD), and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24-48 h after PTMC.
  
  
  RESULTS
  Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), and R-IAEMD (p < 0.001). There were no changes in Pmax, Pmin, and PWD immediately after PTMC.
  
  
  CONCLUSIONS
  Successful PTMC has a favorable early impact on inter- and intra-atrial electromechanical delays, which are considered as novel parameters of atrial electromechanical remodeling in MS patients. Prospective large-scale studies are required to confirm whether improvement in these markers translates into reduced long-term AF risk.
authors.affiliation: Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India. Electronic address: jahangir3582@gmail.com.
authors.forename: Jahangir Rashid
authors.initials: JR
authors.lastname: Beig
authors.affiliation: Prof. & Head, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Nisar A
authors.initials: NA
authors.lastname: Tramboo
authors.affiliation: Professor, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Hilal A
authors.initials: HA
authors.lastname: Rather
authors.affiliation: Asst. Professor, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Imran
authors.initials: I
authors.lastname: Hafeez
authors.affiliation: DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Vijai
authors.initials: V
authors.lastname: Ananth
authors.affiliation: Assoc. Professor, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Ajaz A
authors.initials: AA
authors.lastname: Lone
authors.affiliation: Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Irfan
authors.initials: I
authors.lastname: Yaqoob
authors.affiliation: Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Bhat
authors.affiliation: DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India.
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Ali
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Atrial electromechanical delay; Mitral stenosis; P-wave dispersion; Percutaneous transvenous mitral commissurotomy