PREOPERATIVE AND POSTOPERATIVE VENTRICULA R ARRHYTHMIAS IN MITRAL REGURGITATION

In order to assess the prevalence and prognosis of ventricular arrhyth mias in patients with surgical mitral regurgitation, a prospective coo perative study was undertaken in 14 French cardiological centres. Seve nty-nine patients (45 men, 34 women, average age 62.8 +/- 12.8 years), who underwent mitral valvuloplasty (44 cases) or valve replacement (3 5 cases), were included. Three 24 hour Holter recordings were performe d before, 15 days and 6 months after surgery. Etiology of mitral disea se was dystrophic in 49 patients, degenerative in 11, rheumatic in 10, post-endocarditis in 3 and undetermined in 6. Only 5 patients had a l eft ventricular ejection fraction less-than-or-equal-to 45 %. Complex ventricular arrhythmias (Lown greater-than-or-equal-to 4) were recorde d before surgery in 22 patients (28 %), more often in dystrophic disea se (17/49 versus 5/30, p = 0.04). No significant correlation was obser ved between the ventricular arrhythmias and the other preoperative fin dings, except for a tendency to an inverse correlation between the lef t ventricular ejection fraction and the Lown grade. Two patients died in the immediate postoperative period (Lown 1) ; 1 died of a non-cardi ac cause at the 2nd month (Lown 4A). The prevalence of complex arrhyth mias was unchanged after surgery (34 % on early Holter and 22 % on lat e Holter recordings) with no difference between valvuloplasty and valv e replacement. In conclusion, these results indicate that ventricular arrhythmias do not influence the early and 6 month postoperative progn osis in mitral regurgitation with good left ventricular function.