Rheumatic mitral valve stenosis and atrial fibrillation – Vicious twins

Mitral valve stenosis is a common disease causing substantial morbidity. It is still particularly prevalent in developing countries, but may also be found in an atypical phenotype in developed countries. [ [1] Chandrashekhar Y. Westaby S. Narula J. Mitral stenosis. Lancet. 2009; 374: 1271-1283 Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar ] Atrial fibrillation (AF) is the most common complication in patients with mitral valve stenosis, occurring in about 40% of patients. [ [2] Selzer A. Cohn K.E. Natural history of mitral stenosis: a review. Circulation. 1972; 45: 878-890 Crossref PubMed Scopus (218) Google Scholar ] Mitral valve stenosis leads to progressive pressure overload of the left atrium, which in turn causes atrial cardiomyopathy with electrical and structural remodelling. These changes could be shown even in mitral valve stenosis patients with normal sinus rhythm and are regarded as precursors to the development of AF. [ [3] John B. Stiles M.K. Kuklik P. Chandy S.T. Young G.D. Mackenzie L. et al. Electrical remodelling of the left and right atria due to rheumatic mitral stenosis. Eur. Heart J. 2008; 29: 2234-2243 Crossref PubMed Scopus (135) Google Scholar ] As we know from other conditions leading to AF, atrial enlargement and fibrosis are important determinants for the development of the arrhythmia. Moreover, AF itself may contribute to atrial enlargement. [ [4] Kim K.H. Kim Y.J. Shin D.H. Chang S.A. Kim H.K. Sohn D.W. et al. Left atrial remodelling in patients with successful percutaneous mitral valvuloplasty: determinants and impact on long-term clinical outcome. Heart. 2010; 96: 1050-1055 Crossref PubMed Scopus (21) Google Scholar ] In patients with mitral valve stenosis, the left atrium does not only show pathologically increased volumes, but also reduced systolic flow and pump dysfunction due to atrial wall stiffness, which may worsen, when AF occurs. [ [1] Chandrashekhar Y. Westaby S. Narula J. Mitral stenosis. Lancet. 2009; 374: 1271-1283 Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar ] Assessment of the left atrial volume and function following percutaneous mitral balloon valvuloplasty: Insights into acute and late impact of atrial fibrillation on atrial remodelingInternational Journal of CardiologyVol. 394PreviewRheumatic mitral stenosis (MS) leads to LA remodeling with disordered electrical activation that may revert with valve intervention. This study aimed to assess the acute and late impact of percutaneous mitral balloon valvuloplasty (PMBV) on LA volume and function in patients with atrial fibrillation (AF) compared with sinus rhythm. Full-Text PDF