ArticleJournal of the American College of Cardiology2019
Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation.
Article in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 3 of them syntheses that pooled it.
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Who cites it
46 citing papers in PubMed, 3 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- 2023 KASNet Guidelines on Atrial Fibrillation Surgery.Journal of chest surgery · 2024Guideline
- Pooled it
- Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease.Global heart · 2020Pooled it
- Article
- Atrial Fibrillation and Clinical Outcomes Following Mitral Transcatheter Edge-to-Edge Repair According to Mitral Regurgitation Etiology.JACC. Asia · 2026Article
- Atrial fibrillation worsens outcome of mitral valve repair for degenerative mitral regurgitation: Long-term follow-up of 959 patients.JTCVS open · 2026Article
- Early mitral valve repair surgery versus active surveillance in asymptomatic severe primary mitral regurgitation-insights from the Dutch AMR registry.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
- The Arrhythmogenic Spectrum of Mitral Valve Disease: Pathophysiology, Risk Stratification, and Surgical Management.Journal of clinical medicine · 2026Review
- Floppy Mitral Valve/Mitral Valve Prolapse: Diagnosis and Clinical Classification in This Continuing Odyssey.European cardiology · 2026Review
- Does Preliminary Chest Shape Assessment Improve the Prognostic Risk Stratification of Symptomatic Individuals with Primary Mitral Regurgitation? A Narrative Review of Traditional and Innovative Prognostic Indicators.Journal of clinical medicine · 2025Review
- Left Atrial Appendage Characteristics Assessed with Cardiac Computed Tomography in Patients with Atrial Fibrillation and Severe Mitral Valve Disease.Yonsei medical journal · 2025Article
- A Machine Learning Approach to Predict Successful Trans-Ventricular Off-Pump Micro-Invasive Mitral Valve Repair.Journal of clinical medicine · 2025Article
- High incidence of permanent pacemaker after Cox-maze IV and mitral valve surgery: a nationwide registry-based study.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.Circulation · 2025Review
- Prognostic Implications of Right Ventricular Dysfunction in Severe Degenerative Mitral Regurgitation.Journal of the American Heart Association · 2025Article
- Echocardiographic assessment of atrial, ventricular, and valvular function in patients with atrial fibrillation-an expert proposal by the german working group of cardiovascular ultrasound.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Review
- Society of cardiothoracic surgery in great Britain and Ireland guidance for adult mitral valve disease and interventions.BMJ surgery, interventions, & health technologies · 2025Article
- Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Prognostic Value of Pre-Operative Transthoracic Echocardiography in Patients with Primary Mitral Regurgitation.Reviews in cardiovascular medicine · 2024Review
- Echocardiographic Assessment of Mitral Valve Prolapse Prevalence before and after the Year 1999: A Systematic Review.Journal of clinical medicine · 2024Review
Corrections and comments
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Authors and funding
21 authors at 9 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundScientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery.
objectivesThis study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term.
methodsPatients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed.
resultsAmong 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001).
conclusionsAF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.
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