Why the study?
Changes in electrocardiographic parameters related to atrial fibrillation risk after mitral valve replacement through right versus left atrial surgical approaches were unknown.
Does mitral valve replacement via right atrial transseptal approach compared to left atrial approach increase P-wave duration and dispersion in patients with rheumatic mitral stenosis?
Does mitral valve replacement via right atrial transseptal approach compared to left atrial approach increase P-wave duration and dispersion in patients with rheumatic mitral stenosis?
The right atrial transseptal approach for mitral valve replacement in rheumatic mitral stenosis leads to greater P-wave changes and higher rates of postoperative atrial fibrillation compared to the left atrial approach.
Right atrial approach was associated with greater P-wave changes and postoperative AF; leaves open optimal approach selection pending randomized trials.
BACKGROUND: Predisposition to atrial fibrillation in mitral valve surgery has been well demonstrated. The changes in electrocardiographic parameters (Pmax, Pmin and P-wave dispersion) related to AF risk are unknown. We aimed to document the relationship between electrocardiographic changes and mitral valve replacement through right or left atrial surgical approaches. METHODS: We retrospectively studied 154 patients, who underwent mitral valve replacement surgery from 2008 to 2018. Seventy-nine patients were operated with right atriotomy and transseptal approach (Group 1), and 75 patents were operated with left atriotomy (Group 2). ECGs obtained at hospital admittance and postoperatively at 24 hours were blindly analyzed. RESULTS: Preoperative demographic characteristics were similar. Pmax, Pmin and P-wave dispersion were similar preoperatively. All parameters increased in both groups compared with the preoperative values (P < .05). Postoperative Pmax, Pmin and P-wave dispersion all were statistically significantly higher with the right atrial approach (P < .05). Postoperative AF also was more common in Group 1 (P < .05). CONCLUSION: Right atrial approach may lead to higher P-wave changes and atrial arrhythmias. This may be due to more extensive surgical disruption. The changes in atrial anatomic structure can increase atrial arrhythmic propensity and can cause atrial fibrillation.
No takes yet. Share an insight, caveat, or question.
Göçer et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: