Eid Fawzy Mohamed, Shoukri Mohamed, Al Sergani Hani, Fadel Bahaa, Eldali Abdulmoniem, Al Amri Mohammed, Canver Charles C
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Catheter Cardiovasc Interv. 2006 Oct;68(4):536-41. doi: 10.1002/ccd.20770.
The long-term effect of balloon mitral valvuloplasty (BMV) on the incidence of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) remains undetermined.
To assess the effect of successful BMV on the incidence of chronic AF in patients with severe MS, compare the results with historical controls, and identify factors associated with AF in such patients.
Retrospective analysis of 382 consecutive patients with severe MS and in sinus rhythm (SR) who underwent successful BMV (post procedure mitral valve area (MVA) > or =1.5 cm(2), mitral regurgitation (MR) < or =2/4) at our hospital and followed-up for 1-15.6 (mean 5.6 +/- 3.9) years with clinical and echocardiographic examination.
Thirty-four (8.9%) patients developed AF at follow-up (group A) and 348 patients (group B) remained in SR. At baseline, and in comparison with group B, patients who developed AF (group A) were older, had higher mitral echo score but equal MVA and left atrial (LA) size. The postprocedure MVA was smaller in group A (1.7 +/- 0.3 cm(2)) than in group B (2.0 +/- 0.2 cm(2;) P = 0.002). At follow-up, and in comparison to group B, group A had smaller MVA (1.5 +/- 0.4 cm(2) vs 1.8 +/- 0.4 cm(2) P <0.0001), larger LA dimension (49.4 +/- 6.5 vs 42 +/- 6.5 mm; P <0.0001) and higher restenosis rate (35% vs 14%; P = 0.001). Multivariate logistic regression analysis identified age at follow-up (P < 0.0001), LA size at follow-up (P = 0.004), and MVA at follow-up (P = 0.006) as predictors of AF.
This study demonstrated favorable effect of BMV on the incidence of AF (8.9%) in patients with severe MS in comparison with reported series (29%) of patients with severe MS with similar baseline characteristics who were not submitted to any intervention. The predictors of AF were age, larger LA, and smaller MVA, at follow-up.
球囊二尖瓣成形术（BMV）对重度二尖瓣狭窄（MS）患者房颤（AF）发生率的长期影响尚不确定。
评估成功的BMV对重度MS患者慢性AF发生率的影响，将结果与历史对照进行比较，并确定此类患者中与AF相关的因素。
对我院382例连续的重度MS且处于窦性心律（SR）的患者进行回顾性分析，这些患者均接受了成功的BMV（术后二尖瓣瓣口面积（MVA）≥1.5 cm²，二尖瓣反流（MR）≤2/4），并通过临床和超声心动图检查进行了1 - 15.6年（平均5.6±3.9年）的随访。
34例（8.9%）患者在随访期间发生AF（A组），348例患者（B组）仍维持SR。在基线时，与B组相比，发生AF的患者（A组）年龄更大，二尖瓣回声评分更高，但MVA和左心房（LA）大小相同。A组术后MVA（1.7±0.3 cm²）小于B组（2.0±0.2 cm²；P = 0.002）。在随访时，与B组相比，A组MVA更小（1.5±0.4 cm²对1.8±0.4 cm²；P <0.0001），LA内径更大（49.4±6.5对42±6.5 mm；P <0.0001），再狭窄率更高（35%对14%；P = 0.001）。多因素逻辑回归分析确定随访时年龄（P <0.0001）、随访时LA大小（P = 0.004）和随访时MVA（P = 0.006）为AF的预测因素。
本研究表明，与报道的具有相似基线特征但未接受任何干预的重度MS患者系列（29%）相比，BMV对重度MS患者AF发生率（8.9%）具有良好影响。AF的预测因素为随访时的年龄、更大的LA和更小的MVA。
