Ventricular arrhythmias in arrhythmic mitral valve syndrome—a prospective continuous long-term cardiac monitoring study. Issue 2 (18th October 2022)

• Record Type: Journal Article
• Authors: Aabel, Eivind W; Chivulescu, Monica; Lie, Øyvind H; Hopp, Einar; Gjertsen, Erik; Ribe, Margareth; Helle-Valle, Thomas M; Edvardsen, Thor; Hegbom, Finn; Dejgaard, Lars A; Haugaa, Kristina H
• Is Part Of: Europace. Volume 25:Issue 2(2023)
• Page Start: 506
• Page End: 516
• Publication Date: 2022-10-18
• Subjects: Mitral valve prolapse -- Ventricular tachycardia -- Sudden cardiac death -- Implantable loop recorder -- Cardiomyopathy -- Mitral annular disjunction; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac182
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Arrhythmic mitral valve syndrome is linked to life-threatening ventricular arrhythmias. The incidence, morphology and methods for risk stratification are not well known. This prospective study aimed to describe the incidence and the morphology of ventricular arrhythmia and propose risk stratification in patients with arrhythmic mitral valve syndrome. Methods: Arrhythmic mitral valve syndrome patients were monitored for ventricular tachyarrhythmias by implantable loop recorders (ILR) and secondary preventive implantable cardioverter-defibrillators (ICD). Severe ventricular arrhythmias included ventricular fibrillation, appropriate or aborted ICD therapy, sustained ventricular tachycardia and non-sustained ventricular tachycardia with symptoms of hemodynamic instability. Results: During 3.1 years of follow-up, severe ventricular arrhythmia was recorded in seven (12%) of 60 patients implanted with ILR [first event incidence rate 4% per person-year, 95% confidence interval (CI) 2–9] and in four (20%) of 20 patients with ICD (re-event incidence rate 8% per person-year, 95% CI 3–21). In the ILR group, severe ventricular arrhythmia was associated with frequent premature ventricular complexes, more non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance (all P < 0.02). Conclusions: The yearly incidence of ventricular arrhythmia was high in arrhythmic mitral valve syndrome patients without previous severe arrhythmias using continuous heart rhythm monitoring. The incidence was even higher in patients with secondary preventive ICD. Frequent premature ventricular complexes, non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance were predictors of first severe arrhythmic event. Graphical Abstract: Graphical Abstract We included 80 patients with arrhythmic mitral valve syndrome followed for 3.1 years; 60 were implanted with a loop recorder (ILR) and 20 had prior implantable cardioverter defibrillator (ICD). Severe ventricular arrhythmia occurred in seven patients (12%) in the ILR-group and four (20%) in the ICD-group. Servier Medical Art. LV = left ventricle, MR = mitral regurgitation, MVP = mitral valve prolapse, NSVT = non-sustained ventricular tachycardia, PVC = premature ventricular complex, VT = ventricular tachycardia.