Prediction of atrial fibrillation in patients with mitral stenosis: role of atrial septal motion vekocity

ABSTRACT

The most important proximate cause of atrial fibrillation [AF] in mitral stenosis [MS] is left atrial[LA] dysfunction, so several studies concerned with LA function assessment - body and appendage- have been undertaken. However, inter atrial septum has not been evaluated in MS. The present study was designed to detect atrial septal motion velocity [ASMV] using Doppler tissue echocardiography in MS patients and to investigate the possible role of ASMV in predicting development of AF in MS. Sixty six MS patients were evaluated by transthoracic echocardiography as well as transesophageal echocardiography where ASMV were recorded by triggering tissue Doppler mode. Patients were divided according to rhythm status and ASMV display. The studied patients displayed 2 characteristic patterns of ASMV, the first pattern showed positive wave at late diastole [D], followed by biphasic waves[+ve and -ye B 1] and negative wave at systole [S] that followed again by biphasic waves[+ve and -ye B2]. All patients with this pattern were in sinus rhythm[SR] and considered as group I. The second pattern was lacking B 2 12 patients with this pattern were in SR and categorized as group II while 33 patients were in AF and categorized as group III. LA dilatation, frequency of LA spontaneous echo contrast and reduced ASMV were increasing from group I to group III. Small MVA and absent B2 Were matched in groups II and III, so group II appeared as transition from group I to group III. Reduced ASMV especially negative waves [S and -ye B[1]] were sensitive and specific predictors for AF especially a bsent B2 which had 100% sensitivity [positive predictive value 100%] and specificity [negative predictive value 100%] for AF prediction. Absence of B2 waves and reduction of other ASMV waves can be used to identify MS patients prone to develop AF with high sensitivity and specificity. These changes appear as preclinical loss in ASMV before the onset of AF