Mitral stenosis and atrial fibrillation

Abstract

Mitral stenosis was noted and described both as clinical picture and pathological finding for the first time by John Mayow in 1669. It took more than a century, when in 1827 Robert Adams recognized that `extremely irregular action of the heart is almost pathognomic of mitral stenosis`.Nowadays, the incidence of atrial fibrillation in mitral stenosis has been estimated to be 40 percent. The ratio of women to men presenting with isolated mitral stenosis is 2:1. Patients who have both the rhythm disorder and valve disease are at 17.5-fold greater risk for stroke compared to those in sinus rhythm. It is well known that as a result of the chronic atrial stretch, structural and electrophysilogical changes appear. They directly correlate with the arrhythmia beginning and recurrences. Noteworthy, recent studies have shown that atrial fibrillation alters the miRNA expression profile of the left atrium of mitral stenosis patients which provide potential new therapeutic targets for atrial fibrillation. Maintenance of sinus rhythm is essential for the exercise capacity and the reduction of mitral stenosis symptoms. Adequate anticoagulation is very important to reduce the risk of thromboembolic incidents. Stroke risk in paroxysmal atrtial fibrillation is not different from that in persistent and permanent. The presence of some type arrhythmia categorizes patients with mitral stenosis as `high risk` which requires oral anticoagulant (vitamin K antagonist) unless contraindicated. Key words: mitral stenosis, atrial fibrillation, arrhythmia