Atrial Fibrillation in Rheumatic Heart Disease

Abstract

Atrial fibrillation is the commonest sustained arrhythmia in rheumatic heart disease and is associated with significant morbidity and mortality. In this review, we discuss its epidemiology, natural course and management with special emphasis on recent developments in understanding and treatment of atrial fibrillation in rheumatic heart disease. Use of direct oral anticoagulants appears promising, especially in developing countries where regular coagulation monitoring is a challenge. Also, restoration and maintenance of sinus rhythm in rheumatic atrial fibrillation appear feasible and may predict better clinical outcomes. Atrial fibrillation in rheumatic heart disease is not only very frequent but also a clinical marker of worse outcomes. Increasing age and left atrial size are the most important predictors for its development. The risk of thromboembolism/disabling stroke is significantly elevated when compared with that with non-valvular atrial fibrillation. Anticoagulation with vitamin K antagonists and ventricular rate control are the mainstay of therapy. However, recent evidence predicts a promising future for direct oral anticoagulants and rhythm control strategies in rheumatic atrial fibrillation.