Sinus Rhythm in Rheumatic Mitral  Stenosis after Balloon Mitral  Valvotomy: Is it Feasible?

Jayaram, Ashwal Adamane; Shukla, Anand; Shah, SR; Nayak, Krishnananda; Prabhu, Sridevi; Pai, Umesh

doi:10.7860/jcdr/2017/19382.9124

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…The authors reported an impressive rate of success with a rhythm control strategy with amiodarone (96% of the patients were in SR at 1 year) with concomitant improvements in symptom status, exercise capacity and quality of life. It should be underlined that it was a highly selected population (LA diameter ≤45 mm and AF duration ≤12 months) and that earlier and more recent studies including higher risk patients were not as successful with rhythm control 30. The authors conclude that rhythm control should therefore be considered as the preferred initial therapy for this group of patients but that the optimal strategy to treat AF after PMC, that is, in the long-term, should be individualised, due to the potential side effects of amiodarone in young patients (mean age 37 years).…”

Section: Medical Therapies Of Af and Its Complicationsmentioning

confidence: 99%

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Iung

Leenhardt

Extramiana

2018

Heart

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Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Pressure overload leads to marked structural and electrical remodelling of left atrium. The frequency of persistent AF increases with age and paroxysmal, asymptomatic, AF seems even more frequent. The occurrence of AF worsens the haemodynamic tolerance of MS and markedly increases the risk of thromboembolic events. AF has a negative impact on the natural history of MS and on its outcome after commissurotomy. The respective indications of rhythm and rate control should be adapted to patient characteristics, particularly the consequences of MS, and take into account the high risk of recurrence of AF. Oral anticoagulant therapy is mandatory when AF complicates MS, regardless of its severity and CHA2DS2-VASc score. Non-vitamin K antagonists oral anticoagulants are not recommended in moderate-to-severe MS due to the lack of data. Percutaneous mitral commissurotomy does not appear to prevent the occurrence of AF in MS but should be considered as the first-line therapy when AF is associated with severe symptomatic MS, followed by the discussion of cardioversion or ablation. AF ablation should be considered in patients with mitral disease requiring intervention, but the ideal timing and techniques are difficult to determine due to the lack of appropriate specific randomised trials in patients with MS.

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Section: Medical Therapies Of Af and Its Complicationsmentioning

confidence: 99%

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Iung

Leenhardt

Extramiana

2018

Heart

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“…The probability of AF development is high with an estimate of 40–70% in patients with MS, owing to the electrical heterogeneity, and non-uniform conduction velocities as a result of left atrial dilatation in response to valve obstruction and the inflammatory and fibrotic changes caused by the rheumatic process [27] . AF adversely causes blood stasis in the left atrial appendage, which can precipitate thromboembolic complications such as ischemic stroke [27] . Different success rates of the PMBV in patients with AF and MS have been reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis

Rmilah

Tahboub

Alkurashi

et al. 2021

IJC Heart & Vasculature

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Aims Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta -analysis approach. Methods MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. Results 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm 2 ; 0.76–0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52–3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65–8.97, p = 0.0003) and decrease in MPG (MD = −7.96 mmHg; −8.73 to −7.20, p < 0.00001), LAP (MD = −10.09 mmHg; −11.06 to −9.12, p < 0.00001), and SPAP (MD = −15.55 mmHg; −17.92 to −13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively Conclusion PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.

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“…75 Limited studies have suggested improved success when either AAD or catheter ablation is combined with a strategy of balloon mitral valvotomy. 76,77 Techniques in AF Ablation AF ablation is mostly performed within the LA and techniques can be broadly divided into ablation of triggers which initiate AF (PV and non-PV foci) and ablation of atrial substrate which maintains AF. While the former is always done, substrate ablation is generally reserved for more persistent forms of AF and its added utility remains unclear.…”

Section: Special Situation: Rheumatic Heart Diseasementioning

confidence: 99%

“…75 Limited studies have suggested improved success when either AAD or catheter ablation is combined with a strategy of balloon mitral valvotomy. 76, 77…”

Section: Chronic Rhythm Controlmentioning

confidence: 99%

Strategies for Rhythm Control in Atrial Fibrillation

Narayanan¹

2020

Indian Journal of Clinical Cardiology

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Atrial fibrillation (AF), the most common arrhythmia encountered worldwide, is associated with significant morbidity. The three important considerations with regard to AF management are stroke prevention, rate control, and rhythm control, with the latter two overlapping to some extent. While antiarrhythmic drugs have had limited success as a rhythm control strategy, being limited by side effects and proarrhythmia, catheter ablation has emerged as a potentially better alternative. Current ablation techniques afford good success for paroxysmal AF, especially when done in experienced centers; however, further improvements and innovations are required to improve results for more persistent forms of AF. The current review critically summarizes the present strategies employed for rhythm control in AF and briefly outlines some of the newer developments in this field.

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Sinus Rhythm in Rheumatic Mitral Stenosis after Balloon Mitral Valvotomy: Is it Feasible?

Cited by 3 publications

References 25 publications

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis

Strategies for Rhythm Control in Atrial Fibrillation

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