Prabhu, Mukund A and Rai, Maneesh K and shenthar, jayaprakash (2016) Histopathological study of left and right atria in isolated rheumatic mitral stenosis with and without atrial fibrillation. Journal of Cardiovascular Electrophysiology, 27 (9). pp. 1047-1054. ISSN 10453873

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Abstract

Background: Mitral stenosis (MS) has the highest incidence of atrial fibrillation (AF) in chronic rheumatic valvular disease. There are very few studies in isolated MS comparing histopathological changes in patients with sinus rhythm (SR) and AF. Objectives: To analyze the histological changes associated with isolated MS and compare between changes in AF and SR. Methods: This is a prospective study on patients undergoing valve replacement surgery for symptomatic isolated MS who were divided into two groups, Group I AF (n=13) and Group II SR (n=10). Intra-operative biopsies performed from five different sites from both atria were analysed for 10 histopathologic changes commonly associated with AF. Results: On multivariate analysis, myocytolysis (OR-1.48, P=0.05) was found to be associated with AF, whereas myocyte hypertrophy (OR-0.21, P=0.003) and glycogen deposition (OR-0.43, p=0.002) was associated with SR. Interstitial fibrosis the commonest change was uniformly distributed across both atria irrespective of the rhythm. Conclusion: SR in rheumatic MS is associated with myocyte hypertrophy whereas myocytolysis is associated with AF. Endocardial inflammation is more common in Left Atrial Appendage irrespective of rhythm. Interstitial fibrosis is seen in >90% of patients

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