Correlation of Left Atrial Size and Atrial Fibrillation in RHD With Mitral Valve Disease

BACKGROUNDAtrial fibrillation (AF), the most common sustained cardiac rhythm disturbance, commonly occurs with rheumatic heart disease, particularly mitral stenosis.Hemodynamic impairment and thromboembolic events result in significant morbidity& mortality.Left atrial (LA) enlargement is one of the elements that evolve in the natural history of mitral stenosis.The objective of this study is to study the relation between echo cardio graphically determined left atrial size and atrial fibrillation in mitral valve disease (MVD). METHODOLOGY50 Patients with rheumatic heart disease with mitral valve disease were studied using ECG and ECHO, excluding patients with congenital heart diseases, non-rheumatic mitral valve disease, essential hypertension, patients undergone PTMC or valvuloplasty or valve replacement, coronary artery diseases, patients on antiarrhythmic drugs, pregnant women.Left atrial dimensions measured by ECHO in patients of MVD and AF on ECG were compared with the left atrial dimension of patients in sinus rhythm. RESULTSIn this study 42 patients had left atrial size >40 mm, 29(93.55%) of them were in atrial fibrillation and only 13(68.42%) were in sinus rhythm.Among 8 patients with left atrial size <40 mm, 2(6.45%) were in atrial fibrillation and 06(31.58%)were in sinus rhythm with p<0.02 which is significant. CONCLUSIONAtrial fibrillation incidence was common when left atrial dimension was above 40 mm.There is a quantitative relation between left atrial size measured echocardiographically and the presence or absence of atrial fibrillation.These results may have therapeutic implication in that it may be possible with echocardiography, to identify patients in sinus rhythm, who are at high risk of developing atrial fibrillation.Prophylactic anticoagulation, antiarrhythmic therapy or both might be considered in management to prevent embolism.