A Clinical Evaluation of Atrial Fibrillation in Rheumatic Heart Disease.

OBJECTIVES To estimate incidence of atrial fibrillation in patients of rheumatic heart disease, to study clinical correlation of atrial fibrillation in term of mitral valve area in mitral stenosis, to estimate incidence of systemic embolization and to find out association of atrial fibrillation with recurrent respiratory infections. MATERIAL AND METHODS Ninty-four cases were assigned with different groups according to type of valvular lesion, age group, sex and severity. The incidence of atrial fibrillation was compared among these groups. Patients were grouped according to the type of valvular lesion, age and mitral valve area. Incidence of different types of systemic embolization was studied in cases suffering from atrial fibrillation. We also looked for association of atrial fibrillation with respiratory tract infections. RESULTS The incidence of atrial fibrillation was 41 out of 94 cases (43.61%). The highest incidence of atrial fibrillation was in the age group of 21-30 yrs (55%) and the incidence was more in females (72.72%) as compared to males (27.27%). The incidence of atrial fibrillation in patients with pure mitral stenosis was 48.2% and in cases of predominant mitral regurgitation 43.3%. The incidence of atrial fibrillation in cases of mitral stenosis with mitral valve area < 1 cm2 was 70.4% as compared to 29.6% in cases of mitral stenosis with mitral valve area > 1 cm2. Out of 41 cases of atrial fibrillation, nine had evidence of systemic embolization out of which six were cerebral (66.66%), two were peripheral (33.33%) and one was mesenteric (16.66%). The respiratory infections were more commonly present in patients with atrial fibrillation as compared to patients without atrial fibrillation (24.39% Vs 5.66%). CONCLUSIONS The incidence of atrial fibrillation is significant in cases of rheumatic heart disease. The incidence is higher in females and in the age group of 21-30 yrs. The incidence of atrial fibrillation increases with severity of valvular stenosis. Systemic embolization is present in significant number of patients with rheumatic heart disease with atrial fibrillation. Cerebral embolization is more common as compared to peripheral and followed by mesenteric. The respiratory tract infection is more commonly present in patients with atrial fibrillation as compared to patients without atrial fibrillation.