The effect of mitral valve replacement on atrial fibrillation behaviour


  • Megavath Motilal Department of Cardiothoracic Surgery, Government General Hospital, Guntur, Andhra Pradesh, India
  • Vijaya Rama Raju Nadakuditi Department of Anaesthesia, Government General Hospital, Guntur, Andhra Pradesh, India
  • Alla Gopala Krishna Gokhale Chief Cardiothoracic, Transplant and Minimal Access Cardiac Surgeon, Department of CT Surgery, Government General Hospital, Guntur, Andhra Pradesh, India
  • Sudhakar Koneru Senior Consultant Cardiothoracic Anaesthesiologist, Department of CT Surgery, Government General Hospital, Guntur, Andhra Pradesh, India
  • Manoj Kumar Moharana Consultant Cardiothoracic Surgeon, Department of CT Surgery, Government General Hospital, Guntur, Andhra Pradesh, India
  • K. V. Ramana Consultant Cardiothoracic Surgeon, Department of CT Surgery, Government General Hospital, Guntur, Andhra Pradesh, India



Atrial fibrillation, Mitral valve replacement, Outcome, Surgery


Background: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms and impairs quality of life. Restoration of the sinus rhythm might lead to a lower incidence of thrombo-embolism and valve-related complications in the postoperative period.

Methods: This non-randomized prospective study was carried out between period April 2015 to December 2018 in the Department of Cardiothoracic and Vascular Surgery, Government General hospital, Guntur, Andhra Pradesh, India. A total of 80 patients underwent mitral valve replacement during the study period. 50 patients out of these were with atrial fibrillation and were part of this study, who underwent mitral valve replacement.

Results: All fifty patients were in atrial fibrillation based on clinical examination and the echocardiogram. 13 patients preoperatively were in atrial fibrillation with fast ventricular rate. These patients were placed on antiarrhythmic drugs to control the ventricular rate prior to mitral valve replacement. After surgery twenty out of fifty (40%) patients reverted to NSR and maintained the same rhythm till the 6 months of follow-up. Twenty-nine (58%) patients continued in atrial fibrillation after surgery.

Conclusions: The results of the present study showed that preoperative atrial rhythm strongly determines postoperative rhythm. In view of the promising results of combined mitral valve and anti-atrial fibrillation surgery, the inescapable conclusion is that the anti-arrhythmic procedure should be offered routinely to all patients with a history of preoperative AF.


Vaturi M, Sangie A, Shapira Y, Feldan A, Fink N, Strasberg B, et al. Impact of atrial fibrillation on clinical status, atrial size and hemodynamics in patients after mitral valve replacement. J Heart Valve Dis. 2001;10(6):763-6.

Prystowsky EN, Benson Jr DW, Fuster V, Hart RG, Kay GN, Myerburg RJ, et al. Management of patients with atrial fibrillation: a statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation. 1996;93(6):1262-77.

Kim KC, Cho KR, Kim YJ, Sohn DW, Kim KB. Long-term results of the Cox-Maze III procedure for persistent atrial fibrillation associated with rheumatic mitral valve disease: 10-year experience. Euro J Cardio-Thoracic Surg. 2007;31(2):261-6.

Hornero F, Rodriguez I, Buendía J, Bueno M, Dalmau MJ, Canovas S et al. Atrial remodeling after mitral valve surgery in patients with permanent atrial fibrillation. J Cardiac Surg. 2004;19(5):376-82.

Obadia JF, El Farra M, Bastien OH, Lièvre M, Martelloni Y, Chassignolle JF. Outcome of atrial fibrillation after mitral valve repair. J Thoracic Cardiovascul Surg. 1997;114(2):179-85.

Lim E, Barlow CW, Hosseinpour AR, Wisbey C, Wilson K, Pidgeon W, et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation. 2001;104(1):59.

Sos FH, Jose, Argudo AM. Anatomic atrial remodelling after mitral valve surgery in permanent atrial fibrillation. Rer Esp Cardiol. 2003;56 (7):674-81.

Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Inter Med. 2001;135(12):1061-73.

Singh BN, Connolly SJ, Crijns HJ, Roy D, Kowey PR, Capucci A, et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. New Engl J Med. 2007;357(10):987-9.

Matsunaga A, Duran CM. Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Circulation. 2005;112(9):453.

Raine D, Dark J, Bourke JP. Effect of mitral valve repair/replacement surgery on atrial arrhythmia behavior. J Heart Valve Dis. 2004;13(4):615-21.

Chua YL, Schaff HV, Orszulak TA, Morris JJ. Outcome of mitral valve repair in patients with preoperative atrial fibrillation. J Thorac Cardiovac Surg. 1994;107:408-15.

Kalik RAK, Maratia CB, D'Avila A, Ludwig FB. Predictive factors for persistence of atrial fibrillation after mitral valve operation. Ann Thoracic Surg. 1999;67(3):614-17.

Sandoval N, Velasco VM, Orjuela H. Concomitant mitral valve or atrial septal defect surgery and the modified cox-maze procedure. Am J Cardiol 1996;77:591-6.






Original Research Articles