Arrhythmogenic Mitral Valve Prolapse

Overview

Journal Arrhythm Electrophysiol Rev

Date 2022 Aug 22

PMID 35990107

Authors

Theofanis George Korovesis

Paraskevi Koutrolou-Sotiropoulou

Demosthenes George Katritsis

Affiliations

Soon will be listed here.

Abstract

Mitral valve prolapse (MVP) is a common condition present in 1-3% of the population. There has been evidence that a subset of MVP patients is at higher risk of sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in the papillary muscles caused by the prolapsing valve. ECG features include ST-segment depression, T wave inversion or biphasic T waves in inferior leads, and premature ventricular contractions arising from the papillary muscles and the fascicular system. Echocardiography can identify MVP and mitral annular disjunction, a feature that has significant negative prognostic value in MVP. Cardiac MRI is indicated for identifying fibrosis. Patients with high-risk features should be referred for further evaluation. Catheter ablation and mitral valve repair might reduce the risk of malignant arrhythmia. MVP patients with high-risk features and clinically documented ventricular arrhythmia may also be considered for an ICD.

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References

POCOCK W, BARLOW J, Marcus R, Barlow C . Mitral valvuloplasty for life-threatening ventricular arrhythmias in mitral valve prolapse. Am Heart J. 1991; 121(1 Pt 1):199-202. DOI: 10.1016/0002-8703(91)90976-o. View

Sniezek-Maciejewska M, Dubiel J, Piwowarska W, Mazurek S, Jaskiewicz J, Kitlinski M . Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse. Clin Cardiol. 1992; 15(10):720-4. DOI: 10.1002/clc.4960151029. View

Fulton B, Liang J, Enriquez A, Garcia F, Supple G, Riley M . Imaging characteristics of papillary muscle site of origin of ventricular arrhythmias in patients with mitral valve prolapse. J Cardiovasc Electrophysiol. 2017; 29(1):146-153. DOI: 10.1111/jce.13374. View

Oliva A, Brugada R, dAloja E, Boschi I, Partemi S, Brugada J . State of the art in forensic investigation of sudden cardiac death. Am J Forensic Med Pathol. 2010; 32(1):1-16. DOI: 10.1097/PAF.0b013e3181c2dc96. View

Bui A, Roujol S, Foppa M, Kissinger K, Goddu B, Hauser T . Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia. Heart. 2016; 103(3):204-209. PMC: 5237392. DOI: 10.1136/heartjnl-2016-309303. View

Otto C, Nishimura R, Bonow R, Carabello B, Erwin 3rd J, Gentile F . 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 143(5):e35-e71. DOI: 10.1161/CIR.0000000000000932. View

Nordhues B, Siontis K, Scott C, Nkomo V, Ackerman M, Asirvatham S . Bileaflet Mitral Valve Prolapse and Risk of Ventricular Dysrhythmias and Death. J Cardiovasc Electrophysiol. 2016; 27(4):463-8. DOI: 10.1111/jce.12914. View

Basso C, Calabrese F, Corrado D, Thiene G . Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardiovasc Res. 2001; 50(2):290-300. PMC: 7202452. DOI: 10.1016/s0008-6363(01)00261-9. View

Han H, Parsons S, Curl C, Teh A, Raaijmakers A, Koshy A . Systematic quantification of histologic ventricular fibrosis in isolated mitral valve prolapse and sudden cardiac death. Heart Rhythm. 2020; 18(4):570-576. DOI: 10.1016/j.hrthm.2020.12.021. View

10.

Syed F, Ackerman M, McLeod C, Kapa S, Mulpuru S, Sriram C . Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome. Circ Arrhythm Electrophysiol. 2016; 9(5). DOI: 10.1161/CIRCEP.116.004005. View

11.

Constant Dit Beaufils A, Huttin O, Jobbe-Duval A, Senage T, Filippetti L, Piriou N . Replacement Myocardial Fibrosis in Patients With Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling, and Arrhythmia. Circulation. 2021; 143(18):1763-1774. DOI: 10.1161/CIRCULATIONAHA.120.050214. View

12.

Han H, Ha F, Teh A, Calafiore P, Jones E, Johns J . Mitral Valve Prolapse and Sudden Cardiac Death: A Systematic Review. J Am Heart Assoc. 2018; 7(23):e010584. PMC: 6405538. DOI: 10.1161/JAHA.118.010584. View

13.

Enriquez-Sarano M . Mitral Annular Disjunction: The Forgotten Component of Myxomatous Mitral Valve Disease. JACC Cardiovasc Imaging. 2017; 10(12):1434-1436. DOI: 10.1016/j.jcmg.2017.03.001. View

14.

Eriksson M, Bitkover C, Omran A, David T, Ivanov J, Ali M . Mitral annular disjunction in advanced myxomatous mitral valve disease: echocardiographic detection and surgical correction. J Am Soc Echocardiogr. 2005; 18(10):1014-22. DOI: 10.1016/j.echo.2005.06.013. View

15.

Essayagh B, Sabbag A, Antoine C, Benfari G, Yang L, Maalouf J . Presentation and Outcome of Arrhythmic Mitral Valve Prolapse. J Am Coll Cardiol. 2020; 76(6):637-649. DOI: 10.1016/j.jacc.2020.06.029. View

16.

Sriram C, Syed F, Ferguson M, Johnson J, Enriquez-Sarano M, Cetta F . Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. J Am Coll Cardiol. 2013; 62(3):222-230. DOI: 10.1016/j.jacc.2013.02.060. View

17.

Han H, Teh A, Hare D, Farouque O, Lim H . The Clinical Demographics of Arrhythmic Mitral Valve Prolapse. J Am Coll Cardiol. 2020; 76(22):2689-2690. DOI: 10.1016/j.jacc.2020.09.591. View

18.

Morady F, Shen E, Bhandari A, Schwartz A, Scheinman M . Programmed ventricular stimulation in mitral valve prolapse: analysis of 36 patients. Am J Cardiol. 1984; 53(1):135-8. DOI: 10.1016/0002-9149(84)90697-0. View

19.

Naksuk N, Syed F, Krittanawong C, Anderson M, Ebrille E, DeSimone C . The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse. Indian Pacing Electrophysiol J. 2017; 16(6):187-191. PMC: 5219837. DOI: 10.1016/j.ipej.2016.10.009. View

20.

Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S . 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease. Rev Esp Cardiol (Engl Ed). 2021; 74(6):545. DOI: 10.1016/j.rec.2021.05.003. View