Abstract Background The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). After percutaneous mitral balloon valvuloplasty (PMBV), the improvement in echocardiographic parameters related to AF risk is unknown. We aimed to assess the interatrial electromechanical coupling by Tissue Doppler Imaging (TDI) echocardiography in MS before and after PBMV. Patients and methods This study included 45 patients with moderate to severe MS who underwent successful PMBV without complication at our clinic and 20 healthy volunteers as a control group. We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated one week after PMBV. Interatrial electromechanical delay (EMD) was measured by TDI before and after PMBV and we compared the results. Results The interatrial EMD (56.4 ± 15.8 vs. 34.6 ± 7.2 ms, p < 0.001) was higher in patients with MS as compared to healthy individuals. The maximum P-wave duration (P-max) and P-wave dispersion (PWD) showed significant positive correlation with the interatrial EMD (r = 0.37, p < 0.05 and r = 0.41, p < 0.05 respectively). There was a highly significant decrease in the interatrial EMD (56.4 ± 15.8 vs. 38.3 ± 10.4 ms, p < 0.001) one week after PBMV. Conclusion The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PMBV.