Abstract 9632: Mitral Regurgitation and Atrial Fibrillation: Is it Worth Cardioverting?
Background: Atrial fibrillation (AF) presents in 30%-40% of patients presenting for mitral regurgitation (MR) surgery but may contribute to functional MR. Although severe MR often inhibits consideration of cardioversion (CV), restoring sinus rhythm (SR) or rate control might yield benefits. We tested the hypothesis that in patients with 3-4+MR, restoring and maintaining SR after CV can significantly improve MR to non-surgical ranges (≤2+MR).
Methods: From a prospectively collected database of CV procedures, we retrospectively identified patients undergoing their first CV with an echo within 1 year showing moderately severe to severe 3-4+MR and with a follow-up echo within 1 year after CV. Their CV had to be successful. Of 9333 patients undergoing first CVs, 433 met inclusion criteria. Patients with intervening valve surgery were excluded. The primary outcome was reduction in MR to ≤2+. Paired t-tests were used to analyze changes in MR, LVEF, and TV. Echocardiographic and clinical predictors of improvement were determined using multivariate regression models.
Results: Paired t-tests showed improvement in MR irrespective of rhythm during follow up, although greater improvement was observed in patients with SR vs AF at follow up (mean pair change (MPC) 0.83 ± 1.05, 95% CI 0.616-1.054, p<0.001 vs 0.47 ± 0.90, 95% CI 0.212-0.727, p=0.001, respectively). 55% of patients with 3-4+MR had no more than moderate (2+) residual MR at follow-up if they maintained sinus rhythm compared to 38% in patients with recurrence of atrial fibrillation (Figure, p=0.033). LVEF and TR also improved with maintenance of sinus rhythm (Figure).
Conclusion: Despite moderately severe to severe MR at baseline, clinically significant improvement in MR was observed after successful CV, especially with maintenance of sinus rhythm at follow up.
- © 2013 by American Heart Association, Inc.