Atrial Refractoriness Early After Percutaneous Mitral Balloon Commissurotomy in Patients with Mitral Stenosis and Sinus Rhythm [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2003; 31(9): 482-488

Atrial Refractoriness Early After Percutaneous Mitral Balloon Commissurotomy in Patients with Mitral Stenosis and Sinus Rhythm

Mustafa Soylu1, Ahmet Duran Demir1, Özcan Özdemir1, Serkan Topaloğlu1, Dursun Aras1, Erdal Duru1, Şule Korkmaz1, Ali Şaşmaz1

Atrial Refractoriness Early After Percutaneous Mitral Balloon Commissurotomy in Patients with Mitral Stenosis and Sinus Rhythm Chronic atrial stretch and rheumatic inflammatory activity leads to atrial dilatation, conduction slowing, and this increases the susceptibility to atrial fibrillation (AF). The aim of this study was to examine the effects of changes in the chronic atrial stretch on atrial refractoriness in early period after percutaneous mitral balloon commissurotomy (PMBC) in patients with mitral stenosis and sinus rhythm. We evaluated the changes in pulmonary arterial pressure (PAP), left atrial (LA) pressure, right atrial (RA) pressure, mean mitral diastolic gradient and mitral valve area beside changes in atrial effective refractory periods (AERPs), AERP dispersion, intra- and interatrial conduction times after PBMC in 25 patients. The following hemodynamic parameters were decreased after PBMV mean diastolic gradient (14.5 ±2.6 - 2.8 1.3 mmHg, p<0.001), PAP (53.1 ±12.6 ? 35.7 ±8.9 mmHg, p<0.001), mean RA pressure (6.2 ±1.0 ? 4.9 ±0.4 mmHg; p=0.03), and LA pressure (25.7 ±4.3 ? 12.5 ±2.6 mmHg, p<0.001) and LA diameter (6.2 ±1.0 ? 4.9 ±0.4, p=0.03). High right atrial (HRA), distal coronary sinus (DCS) and right posterolateal (RPL) AERP?s were increased (216 ±15.0 ? 251.1 ±17.1; 266.7 ±17.5 ? 269.5 ±24.8; 207.6 ±20.4 ? 259.2 ±20.7 msec) (p<0.001) and AERP dispersion (55.2 ±5.5 ? 21.5 ±4.7 msec, p<0.001), PAHIS (52.7 ±5.9 ? 39.1 ±4.2 msec, p<0.001) and HRA-DCS interval (65.5 ±14.8 ? 47.5 ±12.9, p<0.001) were significantly decreased. Linear regression and correlation analyses revealed that only the changes in AERP dispersion was correlated with changes in LA pressure.
CONCLUSION
Relief of chronic atrial stretch results in an increase in AERPs and decrease in AERP dispersion suggesting the potential reversibility of the electrophysiological features of chronic atrial dilatation. Beside the hemodynamic changes, the decrease in sympathetic activity after PMBC may also affect the atrial conduction properties and vulnerability.

Keywords: Atrial refractoriness, mitral stenosis, percutaneous mitral balloon commissurotomy

How to cite this article
Mustafa Soylu, Ahmet Duran Demir, Özcan Özdemir, Serkan Topaloğlu, Dursun Aras, Erdal Duru, Şule Korkmaz, Ali Şaşmaz. Atrial Refractoriness Early After Percutaneous Mitral Balloon Commissurotomy in Patients with Mitral Stenosis and Sinus Rhythm. Turk Kardiyol Dern Ars. 2003; 31(9): 482-488
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