Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death.

@article{Basso2019MitralVP,
  title={Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death.},
  author={Cristina Basso and Sabino Iliceto and Gaetano Thiene and Martina Perazzolo Marra},
  journal={Circulation},
  year={2019}
}
Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous disease, mid-systolic click, repolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without… 

Figures and Tables from this paper

Mitral valve prolapse as cause of terminal ventricular complex ischaemia: a clinical case

TLDR
Mitral valve prolapse caused an ischaemic ST-T segment depression in a young woman indicating a high risk of sudden cardiac death and need for immediate drug therapy, according to Russian recommendations on treatment of connective tissue dysplasia.

Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

TLDR
The incidence of ventricular arrhythmias and SCD in patients with MVP, the association with mitral annular disjunction, mechanisms of arrh rhythmogenesis, methods for arrhythmic andSCD risk stratification, findings with multimodality imaging, and treatments for the primary and secondary prevention of SCD are summarized.

Presentation and Outcome of Arrhythmic Mitral Valve Prolapse.

Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death: A Review.

TLDR
Findings from this review suggest that SCD can occur earlier in the course of MVP from complex arrhythmias that are triggered by the repeated tugging and traction of the chordopapillary muscle unit and basal mid-myocardium, even before macrofibrosis can be identified in these regions by late gadolinium enhancement on cardiac magnetic resonance imaging.

Arrhythmogenic Mitral Valve Prolapse

TLDR
Echocardiography can identify MVP and mitral annular disjunction, a feature that has significant negative prognostic value in MVP, and Cardiac MRI is indicated for identifying fibrosis.

Replacement Myocardial Fibrosis in Patients With Mitral Valve Prolapse

TLDR
LV replacement myocardial fibrosis is frequent in patients with MVP; is associated with mitral valve apparatus alteration, more dilated LV, MR grade, and ventricular arrhythmia; and is independently associated with cardiovascular events.

Developing a Mechanistic Approach to Sudden Death Prevention in Mitral Valve Prolapse

TLDR
The clustering of cardiac morphological and electrophysiological characteristics similar to AMVP in otherwise idiopathic SCD suggests that MMVP arises when specific arrhythmia modulators allow for VF initiation and perpetuation through action potential prolongation, repolarization heterogeneity and Purkinje triggering.

Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification

TLDR
This work offers a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and the state-of-the-art imaging-based diagnosis of mitral valve prolapse and investigates multimodality imaging features, such as alterations of anatomy and function of the mitral valves and its leaflets.

Parameters associated with ventricular arrhythmias in mitral valve prolapse with significant regurgitation

TLDR
In patients with MVP with moderate-to-severe MR, symptomatic VA are relatively frequent and associated with significant MV annular abnormalities, subtle left ventricular function impairment and heterogeneous contraction.

Autoimmune Myocarditis and Arrhythmogenic Mitral Valve Prolapse: An Unexpected Overlap Syndrome

TLDR
In patients with recurrent VF episodes despite evidence-based medical treatment for myocarditis, MVP should be considered as an alternative arrhythmogenic substrate, and warrants early ICD implant and PVC-targeted therapy.
...

References

SHOWING 1-10 OF 111 REFERENCES

Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death

TLDR
Comparison-enhanced cardiac magnetic resonance may help to identify in vivo this concealed substrate for risk stratification of ventricular electric instability, an underestimated cause of arrhythmic SCD in young adult women.

Malignant Ventricular Arrhythmias in Patients with Mitral Valve Prolapse and Mild Mitral Regurgitation

TLDR
It is concluded that a selected subset of patients with MVP, malignant ventricular arrhythmias, and miid mitral regurgitation are at risk of sudden death.

The Syndrome of Systolic Click, Murmur, and Mitral Valve Prolapse‐A Cardiomyopathy?

TLDR
Results indicate that LV dysfunction, possibly related to a primary myocardial disorder, is a significant component of the syndrome of prolapsed mitral valve leaflet.

The Mitral Annulus Disjunction Arrhythmic Syndrome.

Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest.

Prevalence and clinical features of mitral valve prolapse.

The Pathophysiology of Idiopathic Mitral Valve Prolapse

TLDR
Cardiomyopathy does not appear to be a primary cause or an important associated component of the IMVP syndrome, and a proposed pathophysiological mechanism to explain the clinical and angiographic findings in IMVP is discussed.
...