When would you consider long-term cardiac monitoring to look for atrial fibrillation in patients with mitral stenosis given their baseline elevated risk for atrial fibrillation and thrombosis?

This is a thought-provoking question. Not only is Afib a risk factor for strokes but these strokes can be particularly devastating. While screening for subclinical Afib in large populations is described, there is little data to show that this leads to clinical benefits (1, 2). The benefit of detecting limited episodes of Afib in the general population needs to be balanced with the uncertain benefit of treating subclinical AFib, particular if the Afib burden is low. On the other hand, the HR for CVA in patients with rheumatic mitral stenosis is significantly higher than any point in the CHADS2-Vasc system, such that any detected patient would be high risk and warrant a strong discussion about anticoagulation. Furthermore, echocardiographic f...

In patients who have underlying substrates, ie., MS, for the generation of atrial arrhythmias it is imperative to determine the arrhythmia burden so that appropriate therapies can be initiated. In patients with mitral valve stenosis, increased left pressures result in the development of myocardial pulmonary vein sleeve stretching with subsequent generation of Electrophysiological aberrations of the once normal myocardium and increased risk of PAF.