Atrial fibrillation in patients with mitral valvulopathy

Abstract

The aim of study was the evaluation of the methods of diagnosis and treatment to the patients with mitral valvulopathy associated with atrial fibrillation (AF). In the course of 2009, 139 pacients were treated with mitral valvulopathy, with the age between 9 and 78 years (with a media of 46,3y.). The reumatismal etiology was found out in 118 cases (85%), myxomatosis in 14 cases (10%), congenital in 7 cases (5%). Atrial fibrillation was found at 64 patients (46%) with the age between 15 and 78 years (media 51,5 years) with a duration from 1 moth to several years. For confirmation has been used ECG in 12 derivations. All the patients were examined with EchoCG, that has evaluated besides the valvular pathology and the sizes of the cardiac cavities, the presence of intracavitary thrombosis (tracked down to 3 patients in left atrium auricle, to 1 patient in right atrium auricle. The thromboembolic anamnesis were present to 6 patients preoperator (9% from the cases of AF), demonstrated though vascular cerebral accidents. All the patients were submissed to the surgical treatment. After surgery the sinusal rhythm recovered spontaneously to 41 patients (64%). To other 21 patients (33%) with AF there was administered Verapamil (for conversion tahisistolic in normosistolic forme), Amiodaron. Acenocumarol or Warfarin was indicated for the prophylaxis of the thromboembolic complications. After surgery, sinusal rhythm recovered to 12 pacients (18%), 8 pacients (12%) were submissive to cardioversion, from wich the rhythm recovered just in 3 cases, 5 pacients went home with persistent AF normosistolic. Frederick post surgey syndrom developed to one patient, caused by the transitor completely atrioventricular flats block. In the first days, two patients (3%) died because of the progressive heart failure. The AF represents the most dangerous rhythm disorders, chiefly to the patients with organic heart disease. The thromboembolic and hemodynamic unsteadiness are the major AF complications. To the patients with mitral valvulophaty, the AF can appear at different terms of evolution of the disease and one of the absolute indications for surgical treatments that have a high efficaciousness in the reestablishment of the sinusal rhythm. The patients, whereat the AF persists after surgery and is refractory to the drugs and electric conversion treatment, will require to continue anticoagulant drugs administration.