Atrial Fibrillation in Rheumatic Heart Disease
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Arrhythmia (R Kabra, Section Editor)
Atrial Fibrillation in Rheumatic Heart Disease Ankit Bansal, MD, DM, FSCAI1 Prattay Guha Sarkar, MD, DM2 Vivek Chaturvedi, MD, DM3,* Address 1 G.B. Pant Institute of Post Graduate Education and Research, New Delhi, India 2 Rajinder Institute of Medical Sciences, Ranchi, India *,3 Narayana Super Speciality Hospital, Gurugram, India Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords Atrial fibrillation I Rheumatic heart disease I Mitral stenosis I Rate control I Rhythm control I Novel oral anticoagulants
Abstract Purpose of review Atrial fibrillation is the commonest sustained arrhythmia in rheumatic heart disease and is associated with significant morbidity and mortality. In this review, we discuss its epidemiology, natural course and management with special emphasis on recent developments in understanding and treatment of atrial fibrillation in rheumatic heart disease. Recent findings Use of direct oral anticoagulants appears promising, especially in developing countries where regular coagulation monitoring is a challenge. Also, restoration and maintenance of sinus rhythm in rheumatic atrial fibrillation appear feasible and may predict better clinical outcomes. Summary Atrial fibrillation in rheumatic heart disease is not only very frequent but also a clinical marker of worse outcomes. Increasing age and left atrial size are the most important predictors for its development. The risk of thromboembolism/disabling stroke is significantly elevated when compared with that with non-valvular atrial fibrillation. Anticoagulation with vitamin K antagonists and ventricular rate control are the mainstay of therapy. However, recent evidence predicts a promising future for direct oral anticoagulants and rhythm control strategies in rheumatic atrial fibrillation.
Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and also an independent predictor of
mortality [1, 2]. AF is associated with a fivefold increase in stroke risk and 25–30% stroke seen in adults can be
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attributed to AF [3]. Atrial fibrillation is a common finding in valvular heart disease, especially mitral valve disease. The association of AF with mitral stenosis (MS) was first reported by Robert Adams in 1827; he said “extremely irregular action of the heart is almost pathognomonic of mitral stenosis” [4]. In 1863, Etienne Marey published a pulse tracing of AF in a patient with mitral stenosis [4]. Since then, while rheumatic heart disease (RHD) and its sequelae have declined precipitously in the western hemisphere, it continues to be a public health problem in low- and middle-income countries and some indigenous populations in developed nations [5, 6]. Unlike non-valvular AF (NVAF), the
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individuals with AF due to RHD are younger with significant cardiac morbidity. Thus, the major complications of atrial
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