title: Evaluation of early direct current cardioversion for maintenance of sinus rhythm in rheumatic atrial fibrillation following successful balloon mitral valvotomy.
abstract: BACKGROUND
  Patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) are at risk for thromboembolism and restoration of sinus rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral valvotomy (PBMV) improves hemodynamics, but may not be enough to restore SR.
  
  
  METHODS
  Prospective randomized study aimed at evaluating efficacy of early direct current cardioversion (DCCV) following successful PBMV in patients with long-standing AF. Group 1 (n=20) had patients of rheumatic MS with AF who underwent successful PBMV. Group 2 (n=15) patients were DC cardioverted and administered oral Amiodarone for 6 weeks. Primary endpoint was maintenance of SR after 6 months. Secondary endpoints were functional capacity, number of embolic episodes, adverse drug effects, and all-cause mortality.
  
  
  RESULTS
  In Group 2, all patients underwent successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group 1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p=0.001), with relative risk of 7.1 (1.95, 25.9, 95% CI, p=0.001) for patients to be in AF who underwent only successful PBMV, i.e. Group 1. There was significant improvement in quality of life (SF36) score in Group 2 (p=0.001), with no deaths, stroke, or adverse drug effects in either group.
  
  
  CONCLUSIONS
  In patients with rheumatic MS and AF, early DCCV and a short-duration oral Amiodarone, following successful PBMV, may be a reasonable strategy to attain long-term SR.
authors.affiliation: Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: drsharmagautam@gmail.com.
authors.forename: Gautam
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Senior Resident, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: R
authors.initials: R
authors.lastname: Anantha Krishnan
authors.affiliation: Senior Resident, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Bohra
authors.affiliation: Additional Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Ramakrishnan
authors.affiliation: Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Nitish
authors.initials: N
authors.lastname: Naik
authors.affiliation: Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Seth
authors.affiliation: Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.affiliation: Scientist-II, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: M
authors.initials: M
authors.lastname: Kalaivani
authors.affiliation: Professor & Head, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Bahl
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Mitral stenosis; Rheumatic atrial fibrillation; Rheumatic heart disease