Long‐Term Effect of Percutaneous Transvenous Mitral Commissurotomy on Atrial Electromechanical Delay and P‐Wave Dispersion in Patients With Severe Mitral Stenosis

Background Rheumatic heart disease (RHD) remains a significant health burden, particularly in low‐ and middle‐income countries, with rheumatic mitral stenosis (MS) contributing substantially to cardiovascular morbidity and mortality. Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for symptomatic MS, yet its long‐term impact on atrial electromechanical properties remains underexplored. Methods We conducted a prospective observational study involving 53 patients (mean age 33.3 ± 6.44 years) who underwent successful PTMC for severe MS. Patients were followed up for a mean duration of 5.34 ± 0.55 years post‐procedure. Atrial electromechanical parameters, including P‐wave dispersion (PWD) and atrial electromechanical delay (AEMD), were assessed using electrocardiography and tissue Doppler echocardiography at baseline, 1 year, 3 years, and 5 years post‐PTMC. Results PTMC resulted in significant improvements in mitral valve area and gradients immediately post‐procedure, which were sustained over the long term. AEMD showed statistically significant improvement at mean 3 years and 5.3 years post‐PTMC, indicating enhanced electromechanical function. Conversely, PWD demonstrated gradual and significant improvement at intermediate follow‐up, with stabilization after 3 years. Patients who developed atrial fibrillation (AF) or restenosis during follow‐up exhibited higher baseline values, suggesting a potential predictive role for these parameters. Conclusion Our study demonstrates that PTMC leads to sustained improvements in atrial electromechanical function indices over long‐term follow‐up. AEMD and PWD serve as valuable markers for assessing atrial remodeling post‐PTMC, with implications for predicting AF and restenosis risk in patients with rheumatic MS.