From the Guidelines
A person can remain in junctional rhythm after mitral valve repair surgery without requiring further treatment if they are asymptomatic, as long as they have a stable heart rate and blood pressure, and do not experience any symptoms. This is because junctional rhythm is a common temporary condition after cardiac surgery, often resolving on its own as the heart heals 1. The key factors in deciding whether to treat junctional rhythm are hemodynamic stability and the presence of symptoms, rather than the rhythm itself 1. Some important points to consider include:
- Junctional rhythm can occur due to inflammation or edema affecting the normal conduction pathways after cardiac surgery 1
- The rhythm often resolves spontaneously within days to weeks as healing progresses 1
- Patients with junctional rhythm should be monitored regularly by a cardiologist, even if no immediate intervention is needed 1
- Periodic ECG monitoring is typically advised to ensure stability, especially if the junctional rhythm persists long-term 1
- The decision to treat should be based on individual patient factors, including hemodynamic stability and symptoms, rather than a one-size-fits-all approach 1. It's also worth noting that the overall management of patients with valvular heart disease, including those who have undergone mitral valve repair surgery, is best done through a multidisciplinary Heart Valve Team 1.
From the Research
Junctional Rhythm After Mitral Repair Surgery
- Patients who undergo mitral valve repair surgery may experience junctional rhythm, which can be a complication of the procedure 2.
- In some cases, junctional rhythm may require permanent pacemaker insertion, especially in patients with atrial functional mitral regurgitation (AFMR) who undergo the maze procedure 2.
- However, asymptomatic patients with junctional rhythm after mitral repair surgery may not require further treatment or surveillance, as long as they are closely monitored for any changes in their condition.
Outcomes of Mitral Valve Repair Surgery
- Mitral valve repair surgery has been shown to be safe and effective, with excellent long-term results, including improved cardiac chamber size and maintenance of postoperative cardiac function 3.
- Patients who undergo robotic mitral valve repair have been found to have low mortality rates and freedom from reoperation, comparable to those of standard open repair 3.
- Percutaneous edge-to-edge mitral valve repair has also been shown to be an effective treatment option for patients with heart failure with preserved ejection fraction (HFpEF) and moderate-severe mitral regurgitation, improving heart failure symptoms and reducing hospitalizations 4.
Management of Junctional Rhythm
- The management of junctional rhythm after mitral repair surgery depends on the individual patient's condition and symptoms 2.
- In some cases, junctional rhythm may be transient and resolve on its own, while in other cases, it may require permanent pacemaker insertion or other treatment 2.
- Transesophageal echocardiography (TEE) can be useful in identifying the etiology of unstable hemodynamics after cardiac surgery, including junctional rhythm 5.