Treatment of Atrial Fibrillation After Surgical Repair of the Mitral Valve

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Abstract
In a series of 484 patients the success of conversion of atrial fibrillation to sinus rhythm following mitral-valve surgery was investigated. A comparison of quinidine therapy and direct-current shock in the treatment of atrial fibrillation was also made. Two groups of patients were investigated: those in chronic atrial fibrillation, pre-existing at the time of the operation, and those with atrial fibrillation developing during the immediate postoperative period. In patients with chronic atrial fibrillation the success rate of restoring and maintaining sinus rhythm was 41.5%. Long-term follow-up revealed, however, that half of those reverted to atrial fibrillation 1 to 2 years after the operation, leaving a final yield of about 20%. Factors influencing the success of treatment were analyzed. Those increasing the probability of success were: short duration of atrial fibrillation prior to the operation, younger age of the patient and unusually good surgical results. Postoperative atrial fibrillation occurred in 34% of patients who at the time of the operation were in sinus rhythm. Sinus rhythm was restored and maintained in 92% of this group. The comparison between quinidine therapy and direct-current shock in restoring sinus rhythm revelaed that the initial success was twice as good in the electro-shock group than in the quinidine group. However, short-term recurrence of atrial fibrillation occurred in half of the former group, so that the actual yield was the same for both methods. The differences between chronic atrial fibrillation and postoperative atrial fibrillation are stressed, the latter being a common postoperative complication, not necessarily related to mitral stenosis and carrying a good prognosis of maintenance of normal rhythm.

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