To Study the Prevalence of Arrhythmias in Valvular Heart Disease and their Correlation with Echocardiographic Variables

Introduction: Valvular Heart Disease (VHD) is an important cause of arrhythmia which may manifest as syncope or palpitations or may be asymptomatic. VHD is very common in India and Rheumatic Heart Disease (RHD) contributes maximally to it. There are a substantial proportion of patients in whom arrhythmias go undetected due to paucity of typical symptoms. The patients with arrhythmias are highly prone to Cerebro Vascular Accidents (CVA) due to thromboembolic phenomenon. Hence, it is important to detect arrhythmias early so that timely preventive measures can be put in place. Aim: Establishing the overall prevalence of arrhythmias in VHD, proportion of asymptomatic arrhythmias, the type of arrhythmias occurring in this population subset and the factors which increase the risk of occurrence of arrhythmias. Materials and Methods: The study included 268 consecutive patients of VHD enrolled between July 2015 to Jun 2016. Patients were evaluated with complete history and clinical examination along with relevant haematological and biochemical investigations, echocardiography and 24 hour ambulatory Holter monitoring. For baseline comparison of patients, chi-square (χ2 ) test was used for descriptive variables. Quantitative variables were compared using the independent sample t-test. Results: It was found that 122 (45.5%) patients had arrhythmias, out of which Atrial Fibrillation (AF) contributed the most 100 (37.3%), followed by Premature Ventricular Contraction (PVC) in 22 (8.9%) patients. There were 19 (12.5%) of the 152 asymptomatic patients who had arrhythmias. Patients of mitral valve disease with AF had a mean Mitral Valvular Area (MVA) of 1.20±0.39 cm2 , Mean-transmitral Gradient (MG) of 14.03±3.10 mm of Hg. The mean Left Atrial (LA) diameter for all the VHD (100 cases) with AF was 48.73±3.57 mm. The mean Left Ventricular Internal Dimension in Diastolic (LVID D) and systolic (LVID S) phase was evaluated for cases of Mitral Regurgitation (MR), Aortic Regurgitation (AR) and Aortic Stenosis (AS) for all the arrhythmias and were found to be 48.74±6.25 mm and 36.69±5.18mm respectively. Conclusion: There is significant proportion of patients with VHD having asymptomatic arrhythmias; hence 24- hour Holter monitoring should be used to detect these early. Echocardiographic variables like LA diameter, MG, MVA, LVID S and LVID D for arrhythmias. The critical point beyond which the patient is more prone to get an arrhythmia as per our study was when LA diameter >43 mm,