Characteristics and Prognosis of Patients with Non-Valvular Atrial Fibrillation and Significant Valvular Heart Disease Referred for Electrical Cardioversion

Abstract Valvular atrial fibrillation (AF) is defined as AF in the presence of mitral stenosis or mechanical valve prosthesis. However, there are patients with AF who have significant native valvular heart disease (VHD) others than mitral stenosis that are classified as nonvalvular AF. The characteristics and prognostic implications of these entities have not been extensively studied. Of 1885 AF patients referred for electrical cardioversion (64±13years, 71% male), 171 (9.1%) had valvular AF (any grade of mitral stenosis or mechanical/biological valve prostheses) and 1714 patients were identified as nonvalvular AF, of whom 329 (17.5%) had significant left-sided VHD. Patients with non-valvular AF but with significant left-sided VHD were older, more frequently women and had more comorbidities compared to the other groups. Furthermore, non-valvular AF patients with significant left-sided VHD showed the worst left ventricular systolic function and largest left atrial volumes. During a median follow-up of 64 months (interquartile range: 33 to 96 months), 488 patients presented with the combined endpoint of all-cause mortality, heart failure hospitalisation and ischemic stroke. Patients with non-valvular AF and with significant left-sided VHD had more events of heart failure whereas patients with valvular AF had higher all-cause mortality events. There were no differences in ischemic stroke events. Type of AF was not associated with outcomes after correcting for echocardiographic variables. In conclusion, the frequency of AF patients with significant VHD is relatively high. The consequences of VHD and AF on cardiac structure and function are more important determinants of adverse outcome than the type of AF.