Management of Persistent Atrial Fibrillation following Balloon Mitral Valvotomy: Safety and Efficacy of Low-dose Amiodarone
Aditya Kapoor MD, DM, Sudeep Kumar MD, DM, Rakesh K. Singh MD, C. M. Pandey PhD, Nakul Sinha MD

Eighty-five patients with severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), who had undergone successful balloon mitral valvotomy (BMV), were studied. The aim was to monitor the role of amiodarone and electrical cardioversion in acute conversion to sinus rhythm (SR), and the long-term efficacy of low-dose amiodarone in maintaining SR. Predictors of acute conversion and maintenance of SR were also identified. Among patients, 39% converted to SR with amiodarone alone, while 52 underwent cardioversion at six weeks. Of the latter patients, 79% converted to SR; hence the overall success rate was 87%. Patients who converted to SR had significantly shorter AF duration and smaller left atrial size. Successful maintenance of SR was possible in 82% of patients at a mean follow up of 30.6 ± 11.1 months (range: 16-43 months). A shorter mean AF duration and smaller left atrial size were the only predictors for maintenance of SR. It is concluded that low-dose amiodarone is safe and effective in restoring and maintaining SR in patients with AF and rheumatic heart disease.