Atrial Electrical and Electromechanical Characteristics in Patients with Rheumatic Mitral Stenosis
Ahmet Güler, Mustafa Bulut, Cihan Dündar, Kürşat Ti̇gen, Tansu Karaahmet, Yeliz Güler, Uğur Aslantaş, Süleyman Efe, Emrah Acar, Süleyman Barutcu, İsmail Balaban, Selçuk Pala
Keywords: Rheumatic mitral stenosis, atrial fibrillation, atrial conduction tine P-wave dispersion, percutaneous mitral balloon valvuloplasty
Introduction: AF in patients with mitral stenosis (MS) causes significant morbidity and mortality. PMBV, which is a treatment of choice for patients with MS, is a highly successful procedure that provides significant improvement in symptoms and echocardiographic parameters. In this study we aimed to demonstrate the probable effects of PMBV on novel echocardiographic and electrocardiographic parameters that can predict the development of AF in 1-year period in patients with MS. Patients and Methods: Twenty-eight patients with moderate or severe rheumatic MS (mean age 37.6 ± 7.4 years; 14 (50%) males) were enrolled this study. All patients who were eligible for this procedure underwent comprehensive echocardiographic examinations with evaluation of ACT measured using tissue Doppler imaging (TDI) before PMBW and repeated at the end of the 1 year after successful PMBV. In addition, 12-lead ECGs were recorded for each patient 1 day before PMBV for the evaluation of baseline maximum and minimum P-wave duration and P-wave dispersion (PWD); this was repeated at the end of the 1 year after successful PMBV. Results: ACT (148.1 ± 20.5 vs 121.3 ± 20.5 p< 0.001), P-max (151.7 ± 15.8 vs 137.3 ± 15.6 p< 0.001) and PWD (84.7 ± 18.8 vs 71.1 ± 18.5 p< 0.001) were found to be significantly decreased after PMBV. A strong positive correlation was detected between ACT, P-max, PWD, LAVi ve PAPs before and after PMBV. In addition, there was a strong correlation between Δ values that were measured by subtracting the baseline measurements from the post-PMBV measurements. Accordingly, ΔACT was correlated with ΔP-max ve ΔPWD (r= 0.5 p= 0.007 and r= 0.55 p= 0.002, respectively). ΔACT, ΔP-max and ΔPWD correlated significantly with only ΔLAVi and ΔPAP in echocardiographic parameters. Conclusion: This study demonstrated that atrial conduction properties that have also been evaluated with ECG and TDI studies significantly correlate with other echocardiographic parameters in patients with MS. In addition, significant improvement occurred in these parameters at the end of the 1 year after PMBV. Further prospective investigations may provide useful data for the detection of the relation between atrial electromechanical characteristics and development of AF in patients with MS.