Thesis title: Arrhythmic form of Mitral valve prolapse: Presentation, Risk stratification and Management
Background : Mitral valve prolapse is a common finding in echocardiography studies that has been considered as benign condition for a long time. However, some anatomic forms have been recently associated with life-threatening ventricular arrhythmias and sudden cardiac deaths (SCD).
Objectives: This study is aiming to clinically characterize and risk stratify patients with malignant phenotype of MVP at high risk for arrhythmias. We aim to explore and to assess potential markers and set formal criteria for MVP induced ventricular arrhythmias that in turn needs for close monitoring, pace makers or even invasive catheter ablation.
Methods: A prospective cohort study of 45 (age 35±8, 29 females), consecutive patients with MVP and/or MAD with comprehensive clinical arrythmia on resting ECG and 48 hours Holter monitoring , Doppler echocardiography characterization and contrast based cardiac magnetic resonance (CMR) were identified. Patients were followed-up for a period of maximum one year to identify any further nanagement needed.
Results: Frequent ventricular arrhythmia was evident (69% with at least ventricular ectopy ≥5%),
as well as complex ventricuar arrhythmia (31% with sustained and non-sustained ventriculat tachcardia) P<0.001. ventricular arrhythmia associated to with MVP was evidently frequent ( Isolated PVC ≥5%)but less frequently complex ( sustained VTor NSVT). AMVP was independently and strongly associated with RBBB morphology on ECG, lae gadolinum enhancement (LGE) on CE-CMR, higher LV volumes (all p <0.05). On Follow-up, Out of 36 patients with ventriclar arrhythmias, 66% were controlled on medical anti-arrhythmics and some others were referred either for ablation after worsenig sysmptoms despite of medical treatment (2%) or Implatable cardioverter device for secondary VT prohylaxis.
Conclusion: Mitral valve prolapse with special characterizations is associated with frequent and complex ventricular arrythmias that needs close follow-up,proper magement approach either medical or and possible further management( ablation, ICD or surgery) . Arrythmic form of MVP is associated with bileaflet prolapse, LGE o mostly at papillary muscle, inferobasal and inferolateral wall and moderate mitral regurge.