Long-Term Effect of Percutaneous Transvenous Mitral Commissurotomy on Atrial Electromechanical Delay and P-Wave Dispersion in Patients With Severe Mitral Stenosis.

BACKGROUND

Rheumatic heart disease (RHD) remains a significant health burden, particularly in low- and middle-income countries, with rheumatic mitral stenosis (MS) contributing substantially to cardiovascular morbidity and mortality. Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for symptomatic MS, yet its long-term impact on atrial electromechanical properties remains underexplored.

METHODS

We conducted a prospective observational study involving 53 patients (mean age 33.3 ± 6.44 years) who underwent successful PTMC for severe MS. Patients were followed up for a mean duration of 5.34 ± 0.55 years post-procedure. Atrial electromechanical parameters, including P-wave dispersion (PWD) and atrial electromechanical delay (AEMD), were assessed using electrocardiography and tissue Doppler echocardiography at baseline, 1 year, 3 years, and 5 years post-PTMC.

RESULTS

PTMC resulted in significant improvements in mitral valve area and gradients immediately post-procedure, which were sustained over the long term. AEMD showed statistically significant improvement at mean 3 years and 5.3 years post-PTMC, indicating enhanced electromechanical function. Conversely, PWD demonstrated gradual and significant improvement at intermediate follow-up, with stabilization after 3 years. Patients who developed atrial fibrillation (AF) or restenosis during follow-up exhibited higher baseline values, suggesting a potential predictive role for these parameters.

CONCLUSION

Our study demonstrates that PTMC leads to sustained improvements in atrial electromechanical function indices over long-term follow-up. AEMD and PWD serve as valuable markers for assessing atrial remodeling post-PTMC, with implications for predicting AF and restenosis risk in patients with rheumatic MS.