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Long-term results of direct-current cardioversion after open commissurotomy for mitral stenosis
Insights
Restoring sinus rhythm (SR) with direct-current (DC) cardioversion after mitral stenosis surgery offers a 50% chance of maintaining SR for 7 years. Long-term atrial fibrillation (AF) or large heart size should not deter attempts at DC cardioversion.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Mitral stenosis is a significant valvular heart disease.
- Atrial fibrillation (AF) is a common complication of mitral stenosis.
- Open mitral commissurotomy is a surgical intervention for mitral stenosis.
Purpose of the Study:
- To determine the long-term cardiac rhythm outcomes after open mitral commissurotomy in patients with mitral stenosis and AF.
- To assess the success rate and influencing factors of direct-current (DC) cardioversion for restoring sinus rhythm (SR).
Main Methods:
- A 7-year observational study involving 106 patients with mitral stenosis and AF who underwent open mitral commissurotomy.
- Cardiac rhythm was monitored before and after surgery.
- Direct-current (DC) cardioversion was employed for patients in AF.
- M-mode echocardiography was used to assess left atrial dimension.
- Pathologic classification of the mitral valve was performed.
Main Results:
- 43 patients achieved SR post-surgery via DC cardioversion and maintained it until hospital discharge.
- 30 patients maintained SR for a mean of 2.5 years (up to 7.2 years).
- The actuarial SR maintenance rate was 50% at 7 years post-surgery among the 43 patients.
- Preoperative AF duration, left atrial dimension, and mitral valve pathology were identified as potential influencing factors for long-term SR maintenance.
- A significant proportion of patients maintaining SR had a history of AF >1 year and a cardiothoracic ratio >60%.
Conclusions:
- Restoring sinus rhythm (SR) through DC cardioversion after mitral commissurotomy in patients with mitral stenosis and AF has a 50% chance of long-term maintenance (7 years).
- Factors like prolonged AF duration and enlarged cardiothoracic ratio should not preclude attempts at secondary DC cardioversion.
- Successful SR maintenance is achievable even in patients with certain preoperative risk factors.
Abstract:
For a 7-year period, cardiac rhythm before and after surgery was determined in 106 patients with mitral stenosis presenting with atrial fibrillation (AF) who had undergone open mitral commissurotomy. Forty-three of the patients reverted to sinus rhythm (SR) after primary or secondary direct-current (DC) cardioversion after surgery and maintained it until discharge from hospital. Thirty patients maintained SR for 3 months to 7.2 years (mean 2.5 years) after surgery. The actuarial maintenance rate of SR was 50% 7 years after surgery in these 43 patients. The duration of AF, preoperative left atrial dimension by M-mode echocardiogram and pathologic classification of the mitral valve were factors supposedly influencing the maintenance of SR for a long period after DC cardioversion. In 30 patients who reverted back to SR and maintained SR late postoperatively, the preoperative duration of AF was up to 5 years, and 35% of the patients had had AF for more than 1 year. Also, in 40% of these 30 patients, the preoperative cardiothoracic ratio was more than 60%. It is concluded that if sinus rhythm is restored by DC cardioversion before discharge from hospital after open mitral commissurotomy, it has a 50% chance of being maintained for 7 years after surgery. Long duration of AF and large cardiothoracic ratio should probably not dissuade one from attempting secondary DC cardioversion in these patients.