Arrhythmic Mitral Valve Prolapse: New Menaces of the Known Disease

Abstract

Mitral valve prolapse (MVP) has long been the subject of intense discussions regarding the prognosis and follow-up tactics. In most cases, this condition has a benign prognosis. However, recent autopsy and follow-up studies have shown risks of developing sudden cardiac death (SCD) in some subgroups of patients who have this clinical phenomenon. The proposed literature review uses the population of patients with MVP with the highest probability of developing life-threatening ventricular tachyarrhythmias. Patients with the presence of a complex of changes, including bicuspid MVP, negative T waves in the inferior and lateral leads on a standard 12-lead electrocardiogram (ECG), and a special anatomical phenomenon called mitral annular disjunction (MAD), are at high risk of developing ventricular ectopias and VSS. A reflection of the high risk of SCD in such patients is the increase of ventricular ectopy according to Holter monitoring. The presence of a bicuspid MVP and the MAD phenomenon, which is a separation of the line of attachment of the posterior mitral leaflet from the basal inferior wall segment towards the atrial wall, determines the presence of a special form of MVP, the so-called arrhythmogenic MVP. Hence, in most cases MVP has a benign prognosis. However, patients with the aforementioned ar- rhythmic MVP signs must be given particular attention and annual follow-up including ECG control, Holter monitoring and echocardiographic examination of the heart to reduce the risk of ventricular tachyarrhythmias and SCD development.

Keywords

• mitral valve prolapse
• mitral annular disjunction
• sudden cardiac death