A prospective study to determine the significance of ventricular late potentials in children with mitral valvar prolapse

Abstract

We aimed prospectively to determine the incidence of ventricular arrhythmias and ventricular late potentials in children with mitral valvar prolapse, and to assess whether signal-averaged electrocardiography could identify which such children were at high risk of developing ventricular tachycardia. In all, we examined 151 children with mitral valvar prolapse, at an age of 12.2 +/- 3.1 years, and 164 healthy subjects aged 12.3 +/- 3.7 years. All children underwent 24-hour ambulatory Holter monitoring and echocardiography. The children with mitral valvar prolapse were followed prospectively for a mean of 64 months. There was a significantly higher prevalence of ventricular arrhythmias in those with prolapse than in the controls (p < 0.0001). Runs of ventricular tachycardia were observed in 3 children with mitral valvar prolapse compared with one from the control group. Late potentials were more frequently observed in the children with mitral valvar prolapse than in those who were healthy (p < 0.0001), and also in those with prolapse suffering ventricular arrhythmias compared with those without ventricular arrhythmias (p < 0.02). During follow-up, 24 children with prolapsing mitral valves developed non-sustained ventricular tachycardia, giving a frequency of 3.1/100 subject-years. The sensitivity of late potentials was low, at 52%, for the identification of children with mitral valvar prolapse who developed ventricular tachycardia, although the specificity was high at 90%. This gave a positive predictive value of 50%, and a negative predictive value of 91%. We conclude that prolapse of the mitral valve predisposes to the development of ventricular arrhythmias and late potentials in children. An abnormal signal-averaged electrocardiogram is a specific, but not very sensitive, predictor for the development of ventricular tachycardia in such children.

QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

“…It is known that ventricular arrhythmias are common in patients with primary MVP (21)(22)(23)(24)(25)(26). In studies involving adults, the frequency of ventricular arrhythmia in patients with primary MVP has been reported with a rate ranging between 49% and 89% depending on the patient group and MVP diagnostic criteria (21)(22)(23) Various causes have been proposed in formation of ventricular arrhythmias in primary MVP.…”

Anterior Mitral Valve Length is Associated with Ventricular Tachycardia in Patients with Classical Mitral Valve Prolapse

“…Ventricular arrhythmias are known to be common in patients with mitral valve prolapse (MVP) 1–3 . Today, noninvasive electrocardiographic methods (heart rate variability [HRV], QT dispersion [QTD], and late potentials) are widely used to determine the risk of developing serious ventricular arrhythmias 4–19 . Echocardiographic correlates of ventricular tachycardia (VT) were also defined in different studies.…”

“…[1][2][3] Today, noninvasive electrocardiographic methods (heart rate variability [HRV], QT dispersion [QTD], and late potentials) are widely used to determine the risk of developing serious ventricular arrhythmias. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Echocardiographic correlates of ventricular tachycardia (VT) were also defined in different studies. In these studies, the degree of mitral regurgitation (MR) and the degree of the prolapsus were shown as inde-pendent predictors of VT. 16,19 However, in some other studies MR was not an independent predictor of ventricular arrhythmias.…”

Arrhythmogenesis in Mitral Valve Prolapse

“…Bobkowski et al carried out a study to determine significance of ventricular late potentials in patients with mitral valve prolapse. 28 Their study included 151 children with mitral valve prolapse and 164 healthy controls. They reported that ventricular late potentials were significantly higher in diseased group as compared to the controls (p<0.0001).…”