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 fibrillation (AF) on the immediate and long-term outcome of patients undergoing percutaneous mitral balloon valvuloplasty (PMV). BACKGROUND There is controversy as to whether the presence of AF has direct negative effect on the outcome after PMV. METHODS The immediate procedural and the long-term clinical outcome after PMV of 355 patients with AF were prospectively collected and compared with those of 379 patients in normal sinus rhythm (NSR). RESULTS Patients with AF were older (62 ± 12 vs. 48 ± 14 years; p < 0.0001) and presented more frequently with New York Heart Association (NYHA) class 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 smaller post-PMV mitral valve are (1.7 ± 0.7 vs. 2 ± 0.7 cm2; p < 0.0001) and lower event free survival (freedom of death, redo-PMV and mitral valve surgery) at mean follow-up time of 60 months (32% vs. 61%; p < 0.0001). In the group of patients in AF, severe post-PMV mitral regurgitation (≥3+) (p = 0.0001), echocardiographic score >8 (p = 0.004) and pre-PMV NYH class IV (p = 0.046) were identified as independent predictors of combined events at follow-up. CONCLUSIONS Patients with AF have worse immediate and long-term outcomes after PMV. However, the presence of AF by itself does not unfavorably influence the outcome, but is marker for clinical and morphologic features associated with inferior results after PMV.