Author + information
- Received April 19, 2011
- Revision received June 6, 2011
- Accepted June 14, 2011
- Published online September 27, 2011.
- Zachary M. Gertz, MD⁎,⁎ (, )
- Amresh Raina, MD⁎,
- Laszlo Saghy, MD†,
- Erica S. Zado, PA-C⁎,
- David J. Callans, MD⁎,
- Francis E. Marchlinski, MD⁎,
- Martin G. Keane, MD⁎ and
- Frank E. Silvestry, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Zachary M. Gertz, 8th Floor Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
Objectives The purpose of this study was to determine whether atrial fibrillation (AF) might cause significant mitral regurgitation (MR), and to see whether this MR improves with restoration of sinus rhythm.
Background MR can be classified by leaflet pathology (organic/primary and functional/secondary) and by leaflet motion (normal, excessive, restrictive). The existence of secondary, normal leaflet motion MR remains controversial.
Methods We performed a retrospective cohort study. Patients undergoing first AF ablation at our institution (n = 828) were screened. Included patients had echocardiograms at the time of ablation and at 1-year clinical follow-up. The MR cohort (n = 53) had at least moderate MR. A reference cohort (n = 53) was randomly selected from those patients (n = 660) with mild or less MR. Baseline echocardiographic and clinical characteristics were compared, and the effect of restoration of sinus rhythm was assessed by follow-up echocardiograms.
Results MR patients were older than controls and more often had persistent AF (62% vs. 23%, p < 0.0001). MR patients had larger left atria (volume index: 32 cm3/m2 vs. 26 cm3/m2, p = 0.008) and annular size (3.49 cm vs. 3.23 cm, p = 0.001), but similar left ventricular size and ejection fraction. Annular size, age and persistent AF were independently associated with MR. On follow-up echocardiogram, patients in continuous sinus rhythm had greater reductions in left atrial size and annular dimension, and lower rates of significant MR (24% vs. 82%, p = 0.005) compared with those in whom sinus rhythm was not restored.
Conclusions AF can result in “atrial functional MR” that improves if sinus rhythm is restored.
Dr. Saghy has received research scholarship grant support from the University of Pennsylvania and from the Rosztoczy Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 19, 2011.
- Revision received June 6, 2011.
- Accepted June 14, 2011.
- American College of Cardiology Foundation