Characteristics and Prognosis of Patients With Nonvalvular Atrial Fibrillation and Significant Valvular Heart Disease Referred for Electrical Cardioversion.

Abstract

Valvular atrial fibrillation (AF) is defined as AF in the presence of mitral stenosis or mechanical valve prosthesis. However, there are patients with AF who have significant native valvular heart disease (VHD) others than mitral stenosis that are classified as nonvalvular AF. The characteristics and prognostic implications of these entities have not been extensively studied. Of 1,885 AF patients referred for electrical cardioversion (64 ± 13years, 71% male), 171 (9.1%) had valvular AF (any grade of mitral stenosis or mechanical/biological valve prostheses) and 1,714 patients were identified as nonvalvular AF, of whom 329 (17.5%) had significant left-sided VHD. Patients with nonvalvular AF but with significant left-sided VHD were older, more frequently women and had more co-morbidities compared with the other groups. Furthermore, nonvalvular AF patients with significant left-sided VHD showed the worst left ventricular systolic function and largest left atrial volumes. During a median follow-up of 64 months (interquartile range: 33 to 96 months), 488 patients presented with the combined endpoint of all-cause mortality, heart failure hospitalization, and ischemic stroke. Patients with nonvalvular AF and with significant left-sided VHD had more events of heart failure whereas patients with valvular AF had higher all-cause mortality events. There were no differences in ischemic stroke events. Type of AF was not associated with outcomes after correcting for echocardiographic variables. In conclusion, the frequency of AF patients with significant VHD is relatively high. The consequences of VHD and AF on cardiac structure and function are more important determinants of adverse outcome than the type of AF.

• Authors: N Mai Vo, Melissa Leung, Phillippe J van Rosendael, Laurien Goedemans, Suzanne E van Wijngaarden, Edgard A Prihadi, Pieter van der Bijl, Nina Ajmone Marsan, Victoria Delgado, Jeroen J Bax
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 128 Pg. 84-91 (08 01 2020) ISSN: 1879-1913 [Electronic] United States
• PMID: 32650929 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants

Topics

• Age Distribution
• Aged
• Anticoagulants (therapeutic use)
• Aortic Valve Insufficiency (diagnostic imaging, epidemiology)
• Aortic Valve Stenosis (diagnostic imaging, epidemiology)
• Atrial Fibrillation (complications, epidemiology, therapy)
• Brain Ischemia (epidemiology)
• Cardiac Valve Annuloplasty (statistics & numerical data)
• Cause of Death
• Echocardiography
• Electric Countershock
• Female
• Heart Failure (epidemiology)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Mitral Valve Insufficiency (diagnostic imaging, epidemiology)
• Mortality
• Prognosis
• Referral and Consultation
• Registries
• Retrospective Studies
• Sex Distribution
• Stroke (epidemiology, etiology, prevention & control)