Objective: To compare rate control and rhythm control strategies in patients with atrial fibrillation (AF) after percutaneous mitral balloon valvotomy (PMV). Methods: 183 patients with AF after successful PMV, with AF duration ( 12 months and post-PMV left atrial (LA) size ( 45 mm, were studied in a prospective, randomised trial. The primary end point was improvement in AF-related symptoms. Secondary study end points were 6 min walk tests, quality of life (QOL), normalisation of LA size, number of hospital admissions and duration of hospital stay. Results: Over one year, 2% patients in the rate control group had sinus rhythm, as compared with 96% of patients in the rhythm control group (p , 0.001). A greater proportion of patients reported improvement in symptoms in the rhythm control group than in the rate control group (p , 0.0001 at every visit time). Walking distance in a 6 min walk test, QOL and LA size normalisation were better in the rhythm control group than in the rate control group. The strategy of rhythm control was associated with similar numbers of hospital admissions but with longer duration of hospital admissions. Drug-related side effect did not differ between the rate control and rhythm control groups. During the follow-up period, no patients in either group had embolic or transitory ischaemic neurological events. Conclusions: In patients with AF after PMV, AF duration ( 12 months and post-PMV LA size ( 45 mm, sinus rhythm was easy and safe to achieve and maintain. Moreover, patients benefited from restoration and maintenance of sinus rhythm in terms of improved AF-related symptoms, 6 min walk tests and QOL, and of LA size normalisation. Rhythm control should therefore be considered as the preferred initial therapy for this group of patients. The optimal strategy to treat AF after PMV should be individualised. M ost patients with rheumatic mitral valvular stenosis and atrial fibrillation (AF) remain in AF rhythm after percutaneous mitral balloon valvotomy (PMV).1-3 AF can adversely affect haemodynamic function. The absence of atrial systole (atrial kick) and a rapid ventricular rate with relative shortening of diastole can increase left atrial (LA) pressure, worsen pulmonary venous congestion and compromise cardiac output. Moreover, stasis of blood in the LA appendage predisposes to development of thrombi and embolic complications.4 AF also generates significant healthcare costs. 5Sinus rhythm is difficult to achieve and maintain in patients with rheumatic mitral valvular stenosis and AF but would be more easily achieved with reduction of LA pressure after successful PMV. 6 In our previous study, we found that longer AF history, smaller mitral valve area and higher LA pressure after PMV are the key factors of AF recurrence.1 Sinus rhythm can be maintained in a higher proportion of patients with AF duration ( 12 months and post-PMV LA size ( 45 mm than of those with AF duration . 12 months and post-PMV LA size . 45 mm.

Serum cTnT concentration measured within 2 weeks of the onset of PPCM was correlated negatively with LVEF at follow-up. This marker offers a simple, quick, inexpensive, non-invasive method for predicting a persistent LVEF of < or =50%. A cTnT concentration of >0.04 ng/ml predicted persistent left ventricular dysfunction with a sensitivity of 54.9% and a specificity of 90.9%.

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