Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation - Immediate and long-term results

OBJECTIVES The purpose of this study was to examine the effect of atrial fi brillation (AF) on the immediate and long-term outcome of patients undergoi ng percutaneous mitral balloon valvuloplasty (PMV). BACKGROUND There is controversy as to whether the presence of AF has a dire ct negative effect on the outcome after PMV. METHODS The immediate procedural and the long-term clinical outcome after P MV of 355 patients with AF were prospectively collected and compared with t hose of 379 patients in normal sinus rhythm (NSR). RESULTS Patients with AF were older (62 +/- 12 vs. 48 +/- 14 years; p < 0.0 001) and presented more frequently with New York Heart Association (NYHA) c lass IV (18.3% vs. 7.9%; p < 0.0001), echocardiographic score >8 (40.1% vs. 25.1%; p < 0.0001), calcified valves under fluoroscopy (32.4% vs. 18.8%, p < 0.0001) and with history of previous surgical commissurotomy (21.7% vs. 16.4%; p = 0.0002). In patients with AF, PMV resulted in inferior immediate and long-term outcomes, as reflected in a smaller post-PMV mitral valve ar ea (1.7 +/- 0.7 vs. 2 +/- 0.7 cm(2); p <: 0.0001) and a lower event free su rvival (freedom of death, redo-PMV and mitral valve surgery) at a mean foll ow-up time of 60 months (32% vs. 61%; p < 0.0001). In the group of patients in AF, severe post-PMV mitral regurgitation (greater than or equal to 3+) (p = 0.0001), echocardiographic score >8 (p = 0.004) and pre-PMV NYHA class IV (p = 0.046) were identified as independent predictors of combined event s at follow-up. CONCLUSIONS Patients with AF have a worse immediate and long-term outcomes after PMV. However, the presence of AF by itself does not unfavorably influ ence the outcome, but is a marker for clinical and morphologic features ass ociated with inferior results after PMV. (J Am Coll Cardiol 1999;34:1145-52 ) (C) 1999 by the American College of Cardiology.