Atrial fibrillation (AF) is independently associated with long-term excess mortality in patients with degenerative mitral regurgitation and should prompt consideration for surgery, researchers advise.

Guidelines for severe degenerative mitral regurgitation in the US and Europe classify AF as a class II indication, meaning it is not as strong an indicator for surgery as symptoms, LV EF<60% or end-systolic diameter of 40 mm or more, co-author Dr Maurice Enriquez-Sarano of Mayo Clinic in Rochester, Minnesota, USA said by email.

However, he said “the available evidence is very slim and the implications of AF in patients with [degenerative mitral regurgitation] are poorly defined.”

Based on the findings of the current study, “We believe the guidelines should list AF as a Class I indication from now on,” said Dr Sarano, who chairs the Mitral Regurgitation International database registry of patients used in the study.