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Outcome of atrial fibrillation after mitral valve repair
J F Obadia1, M el Farra, O H Bastien
1Hôpital Cardiologique Louis Pradel, Lyon, France.
Insights
Restoring sinus rhythm after mitral valve repair is more successful for patients with recent-onset atrial fibrillation. Preoperative rhythm and atrial fibrillation duration significantly impact the success of maintaining sinus rhythm post-surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Clinical Prognostics
Background:
- Atrial fibrillation is common in patients undergoing mitral valve repair.
- Preoperative cardiac rhythm influences outcomes after mitral valve surgery.
Purpose of the Study:
- To identify prognostic factors for achieving and maintaining sinus rhythm after mitral valve repair.
- To assess the impact of preoperative rhythm on surgical outcomes.
Main Methods:
- Retrospective analysis of 191 patients undergoing mitral valve repair.
- Evaluation of preoperative rhythm, atrial fibrillation duration, and left atrial characteristics.
Main Results:
- Preoperative sinus rhythm, shorter atrial fibrillation duration (<1 year), and less left atrial hypertrophy predict successful return to sinus rhythm.
- High success rates (93.7%) for sinus rhythm maintenance when present preoperatively; 80% for intermittent or <1 year AF.
- No significant difference in long-term survival between patients with preoperative sinus rhythm or atrial fibrillation.
Conclusions:
- Mitral valve repair should prioritize patients with sinus rhythm or recent-onset atrial fibrillation.
- Surgery to restore sinus rhythm may benefit patients with long-standing atrial fibrillation if mortality risk is not prohibitive.
Objective:
The aim of the study was to evaluate the prognostic factors for return to sinus rhythm after mitral valve repair.
Method:
One hundred ninety-one patients underwent surgery for mitral valve repair, including 142 procedures for valve repair only (74%). The patients with preoperative atrial fibrillation (50.5%) were older, clinically more symptomatic, and had a greater degree of left atrial dilation than the patients who had sinus rhythm.
Results:
Preoperative cardiac rhythm, the duration of preoperative atrial fibrillation, and a lesser degree of left atrial hypertrophy are significant prognostic factors independent of the maintenance of sinus rhythm. The probability of return to stable sinus rhythm was 93.7% when sinus rhythm was already present before the operation and 80% when atrial fibrillation was intermittent or of less than 1 year's duration; probability declined abruptly for durations over 1 year. No significant difference in patient survival was noted between those who had sinus rhythm (99% +/- 0.9% at 1 year and 86% +/- 6.6% at 5 years) and those who had atrial fibrillation in the preoperative period (95% +/- 3.1% at 1 year and 86% +/- 8.4% at 5 years). In contrast, the postoperative return to sinus rhythm was associated with 99% +/- 0.9% and 94% +/- 4.8% survivals at 1 and 4 years versus 97% +/- 1.5% and 77% +/- 13% in the event of postoperative atrial fibrillation.
Conclusion:
The aim of restoring postoperative sinus rhythm after mitral valve repair should lead to surgery being conducted on patients who have sinus rhythm or recent-onset atrial fibrillation. Surgery for atrial fibrillation may be of value in patients with a long history of atrial fibrillation, providing that it does not induce prohibitive excess mortality.