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Effects of Atrial Fibrillation Cardioversion after Percutaneous Mitral Balloon Valvuloplasty on Echocardiographic Left and Right Atrial Functions

Amongst patients with mitral stenosis (MS), the most common complication is AF. Our study aimed at evaluating the effect of AF cardioversion after Percutaneous Mitral Balloon Valvuloplasty (PMBV) on echocardiographic atrial functions.

The study included 34 patients with MS and AF, presenting to Ain-shams University hospitals, who underwent successful PMBV then randomized into 2 different groups according to AF management strategy. Group-I patients (n=16) received DC cardioversion after amiodarone infusion (within 24 hours post-PMBV) in addition to anticoagulation. Group-II patients (n= 18) were kept on the rate control strategy for AF and  anticoagulation. Atrial functions were evaluated by echocardiography before and 48-72 hours after PMBV.

Both groups were homogenous regarding demographic, clinical and echocardiographic data before PMBV. Both groups showed significant improvement in MVA (Group-I: 0.953 ± 0.144cm2 to 2.26 ± 0.463cm2, p=0.000, Group-II: 0.942 ± 0.171cm2 to 1.95 ± 0.40cm2 , p=0.0000) , left atrial emptying fraction (Group-I: 16.11 ± 6.93% to 26.16 ± 5.51%, p=0.000 , Group-II: 18.49 ± 5.47% to 26.12 ± 7.68%, p=0.002), left atrial function index (Group-I: 4.48 ± 2.32 to 6.84 ± 3.35, p=0.001 , Group-II: 3.34 ± 1.42 to 7.80 ± 4.17, p=0.006) as well as estimated systolic pulmonary artery pressure (Group-I: 49.06 ± 13.86 to 38.25 ± 7.29, p=0.01 , Group-II: 53.44 ± 14.52 to 39.88 ± 10.67, p=0.003). For group-I patients, reduction in left atrial end-diastolic volume was significant (120.84 ± 32.82 mL to 95.31 ± 19.27mL, p=0.012) and TAPSE showed significant improvement (17.57± 4.96 to 21.08 ± 2.52, p=0.018). When percentage improvement in variables was compared between both groups, none of the indices used to evaluate atrial functions showed any significant difference between both groups.

Atrial functions improve post-PMBV. No additional improvement in atrial functions occurs after cardioversion in patients who have already undergone PMBV, at least within 72-hours.


Credits: Sameh Samir; Amal Ayoub; Said Khaled; Hossam Zaki

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