Short Term Effect of Percutaneous Mitral Commissurotomy on P Wave Dispersion in Patients with Mitral Stenosis

The Medical Journal of Cairo University Pub Date : 2023-09-01 DOI:10.21608/mjcu.2023.325793

D. E. A. K. M. ABDELRAHMAN ELSAYED ATTIA, M.D.;, O. R. M. SAMEH SAMIR RAAFAT NAGUIB, M.D.;

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Abstract

Background: Percutaneous mitral commissurotomy now has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis with good immediate hemodynamic outcome, low complication rates, and clinical improvement. P-wave dispersion (PWD) is a noninvasive (ECG) marker for atrial remodeling and predictor for atrial fibrillation. Effect of PMC on risk of atrial fibrillation is not well studied. Aim of Study: To evaluate the effect of percutaneous mitral commissurotomy on P wave dispersion to assess the risk of atrial fibrillation. Patients and Methods: This study is a prospective study which was on 36 patients with significant mitral stenosis (MV Area less than 1.5cm 2 ) presenting to Cardiology Department at Ain Shams University Hospital at 2022, all patients underwent PMC and ECG before PMC, 24 hours after PMC and two months after PMC. Results: The comparison of MVA, PWD and LA volume before, 24 hours postoperatively and at two months follow-up after PMC, showed that there was significant increase in MVA at 24 hours postoperatively from (0.87 – 0.2cm 2 ) to (2.01 – 0.21cm 2 ) p -value <0.001. P wave dispersion (PWD) showed significant decrease 24 hours after PMC from (63.33 – 11.71ms) to (51.39 – 9.23ms) after 24 hours and to (39.31 – 11.03ms) two months after PMC p -value <0.001. Also, left atrial volume (LA volume) showed significant decrease from (113.19 – 21.6ml) to (102.22 – 21.87ml) 24 hours after PMC and to (88.75 – 21.04ml) two months after PMC p -value <0.001. P wave dispersion (PWD) decreased in 27 patients (75%) 24 hours after PMC and in 33 patients (91.7%) after two months after PMC among suited patients. Conclusion: Percutaneous mitral commissurotomy was safe and effective in the treatment of mitral stenosis, it was associated with significant reduction in P-wave dispersion and left atrial volume and increase in mitral valve area as well as reduced risk of atrial fibrillation.

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经皮二尖瓣环切开术对二尖瓣狭窄患者 P 波弥散的短期影响

背景：目前，经皮二尖瓣环切开术已成为治疗严重柔韧型风湿性二尖瓣狭窄的首选方法，具有良好的即刻血液动力学效果、低并发症发生率和临床改善效果。P波弥散（PWD）是心房重塑的无创（心电图）标记和心房颤动的预测指标。PMC 对心房颤动风险的影响尚未得到充分研究。研究目的评估经皮二尖瓣裂切开术对 P 波弥散的影响，以评估心房颤动的风险。患者和方法：本研究是一项前瞻性研究，对象是 2022 年到艾因夏姆斯大学医院心脏科就诊的 36 名二尖瓣口明显狭窄（二尖瓣口面积小于 1.5 厘米 2）患者，所有患者均接受了经皮二尖瓣环切开术，并在经皮二尖瓣环切开术前、经皮二尖瓣环切开术后 24 小时和经皮二尖瓣环切开术后两个月分别进行了心电图检查。结果：PMC 术前、术后 24 小时和术后两个月随访的 MVA、PWD 和 LA 容积比较显示，术后 24 小时 MVA 从（0.87 - 0.2cm 2 ）显著增加到（2.01 - 0.21cm 2 ），P 值小于 0.001。P波弥散（PWD）显示，PMC术后24小时后明显下降，从（63.33 - 11.71ms）降至（51.39 - 9.23ms），PMC术后两个月后降至（39.31 - 11.03ms），P-值＜0.001。此外，左心房容积（LA 容积）也从 PMC 24 小时后的（113.19 - 21.6 毫升）显著降至（102.22 - 21.87 毫升），PMC 两个月后降至（88.75 - 21.04 毫升），P-值＜0.001。在接受 PMC 治疗的患者中，27 名患者（75%）在 PMC 24 小时后 P 波弥散度（PWD）下降，33 名患者（91.7%）在 PMC 两个月后 P 波弥散度（PWD）下降。结论：经皮二尖瓣环切开术治疗二尖瓣狭窄安全有效，可显著降低P波弥散和左心房容积，增加二尖瓣面积，降低心房颤动风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Medical Journal of Cairo University

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