Percutaneous balloon mitral commissurotomy significantly reduced mean left atrial pressure from 18.5 to 10.2 mm Hg (P<0.001), with pressure changes correlating with AF vulnerability (r=0.7, P=0.02).
Observational (n=34)
Does percutaneous balloon mitral commissurotomy improve electrophysiological remodeling in patients with chronic atrial fibrillation and mitral stenosis?
Immediate reduction of left atrial stretch via PBMC improves electrophysiological parameters in sinus rhythm patients but shows prolonged, heterogeneous recovery in chronic AF patients, suggesting irreversible regional conduction changes.
Effect estimate: r=0.7
p-value: p=<0.001
BACKGROUND: Mechanoelectrical feedback caused by atrial dilatation plays an important role in atrial fibrillation (AF). To test the hypothesis that remodeling is reversible by reducing atrial stretch, we investigated electrophysiological changes after a reduction of left atrial (LA) pressure in patients undergoing percutaneous balloon mitral commissurotomy (PBMC). METHODS AND RESULTS: In 22 patients with chronic AF who were undergoing PBMC for mitral stenosis, internal cardioversion was successful in 19 patients (86%). Twelve patients with sinus rhythm acted as controls. Mean LA pressure was significantly reduced after PBMC (18.5+/-5.9 mm Hg versus 10.2+/-4.1 mm Hg; P<0.001). The effective refractory period (ERP), conduction delay (CD), and the index of heterogeneity (CoV) of the ERP and CD were compared. Changes in LA pressure were only significantly correlated with AF vulnerability (r=0.7; P=0.02) and CoV of CD (r=0.3; P=0.03). There were no significant changes in ERP and CD immediately after PBMC in the AF group. However, the overall CoV of ERP was reduced in the AF group after PBMC. There were homogenous, although not significant, increases in regional ERP in the control group immediately after PBMC. Atrial CD and CoV of CD were significantly reduced after PBMC in the control group; this was most prominent within the regions of the LA. CONCLUSIONS: AF vulnerability and CoV of CD correlated significantly with LA pressure. A homogenous increase in regional ERPs could be demonstrated in the control group after an immediate reduction of atrial stretch, whereas the recovery course of electrical remodeling was prolonged and heterogenous in the AF group. Regional conductions were irreversible in patients with preexisting AF.
Fan et al. (Tue,) conducted a observational in Chronic atrial fibrillation and mitral stenosis (n=34). Percutaneous balloon mitral commissurotomy (PBMC) vs. Sinus rhythm controls was evaluated on Left atrial pressure reduction and correlation with AF vulnerability (r=0.7, p=<0.001). Percutaneous balloon mitral commissurotomy significantly reduced mean left atrial pressure from 18.5 to 10.2 mm Hg (P<0.001), with pressure changes correlating with AF vulnerability (r=0.7, P=0.02).