%0 Journal Article
%T Outcome of tailored therapy in rheumatic heart disease with persistent atrial fibrillation (RHD-AF).
%A Saggu DK
%A Subramaniam M
%A Korabathina R
%A Raju BS
%A Atreya AR
%A Reddy P
%A Kumar DN
%A Menon R
%A Yalagudri S
%A Kapadiya A
%A Chennapragada S
%A Narasimhan C
%J Pacing Clin Electrophysiol
%V 47
%N 8
%D 2024 Aug 4
%M 38963723
%F 1.912
%R 10.1111/pace.15041
%X <B>BACKGROUND: </B>Rheumatic heart disease with persistent atrial fibrillation (RHD-AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD-AF.<BR><B>METHODS: </B>Consecutive patients with RHD-AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT-proBNP, 6-Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow-up.<BR><B>RESULTS: </B>Eighty-three patients with RHD-AF (mean age 56.13 ± 9.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04 ± 7.14 months. These patients had improved functional class, lower NT-proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15 ± 1.29 vs 6.93 ± 5.23, p = 0.041). Thirty-five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters.<BR><B>CONCLUSIONS: </B>RHD-AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations.