Late potentials in mitral valve prolapse

Jabi, Haytham; Burger, Andrew J.; Orawiec, B; Touchon, Robert C.

doi:10.1016/0002-8703(91)90575-3

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…Certain studies have found women to be at higher risk 26, 31 though we did not find this in the present study. Using signal-averaged ECG, an increased frequency of late potentials has been identified in MVP patients 19 ; however the utility in risk prediction is unclear 32 . Similarly, programmed electrical stimulation does not appear to be conclusively helpful 33, 34 .…”

Section: Discussionmentioning

confidence: 99%

Mitral valve prolapse and sudden cardiac arrest in the community

et al. 2016

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Background Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, the association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial. Objective To ascertain the frequency of MVP among SCA cases in the community and characterize the clinical profile of SCA cases with MVP Methods SCA cases were prospectively identified in the population-based, Oregon Sudden Unexpected Death Study (population approximately 1 million). Presence of MVP was identified from echocardiograms performed prior but unrelated to the SCA event. The detailed clinical profile of SCA cases with MVP was compared to those without MVP to identify potential differences. Results 729 SCA cases were evaluated over a 12 year period (69.5 ± 14.8 years; 64.6% male). MVP was seen in 17 cases pre-arrest (2.3%; 95% CI 1.2 to 3.4%). Mitral regurgitation (MR) was present in 14 (82.3%) MVP-SCA cases, and was moderate or severe in 10 (58.8%). Compared to cases without MVP, MVP-SCA cases were younger (60.9 ± 16.4 vs 69.7 ± 14.7; p=0.02), with fewer risk factors (diabetes 5.9% vs 46.4%; p=0.001; hypertension 41.2% vs 78.9%; p=0.001) or known coronary disease (29.4% vs 65.6%; p<0.001). Conclusion MVP was observed in a small proportion (2.3%) of SCA cases in the general population, suggesting a low risk overall. Since MVP-SCA cases were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency, as well as genetics could aid future risk stratification approaches.

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Section: Discussionmentioning

confidence: 99%

Mitral valve prolapse and sudden cardiac arrest in the community

et al. 2016

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“…In a previous study the prevalence of late potentials in adults with prolapsing valves was shown to be between 22 and 38%, significantly higher than in controls. 1 ' 4 ' 17 Banasiak et al, 18 however, observed no significant differences in the prevalence of late potentials in patients with mitral valvar prolapse and in similarly selected controls. Jabi et al 17 and Costa et al 19 found no significant correlation between the presence of late potentials and ventricular arrhythmias in adults with mitral valvar prolapse.…”

Section: Discussionmentioning

confidence: 94%

“…1 ' 4 ' 17 Banasiak et al, 18 however, observed no significant differences in the prevalence of late potentials in patients with mitral valvar prolapse and in similarly selected controls. Jabi et al 17 and Costa et al 19 found no significant correlation between the presence of late potentials and ventricular arrhythmias in adults with mitral valvar prolapse. Some investigators, in contrast, have observed an association between the presence of late potentials and the occurrence of spontaneous ventricular tachycardia.…”

Section: Discussionmentioning

confidence: 94%

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

et al. 2002

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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.

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“…SAECG abnormalities are associated with an increased risk of ventricular arrhythmias and sudden cardiac death in both ischemic and non-ischemic cardiomyopathies, arrhythmogenic right ventricular cardiomyopathy, and Brugada syndrome [ 71 ]. Studies involving SAECG showed an increased frequency of late potentials in MVP patients but without clear risk prediction [ 72 , 73 , 74 , 75 , 76 , 77 ]. These studies concluded that late potentials are a common finding in patients with MVP and that they may be regarded as a risk modifier in conjunction with other clinical/imaging findings [ 15 , 72 , 73 , 74 , 75 ].…”

Section: Phenotypic Characterization and Risk Stratificationmentioning

confidence: 99%

“…Studies involving SAECG showed an increased frequency of late potentials in MVP patients but without clear risk prediction [ 72 , 73 , 74 , 75 , 76 , 77 ]. These studies concluded that late potentials are a common finding in patients with MVP and that they may be regarded as a risk modifier in conjunction with other clinical/imaging findings [ 15 , 72 , 73 , 74 , 75 ]. To the best of our knowledge, the are no studies comparing late potentials on SAECG and areas of scar/late potentials at EAM in AMVP patients; however, as previously proposed in the setting of ischemic and nonischemic cardiomyopathy [ 78 , 79 ], we may speculate that late potentials at SAECG may be included among the risk markers (i.e., syncope or family history of SCD) that, if present, may suggest the application of a two-step approach in risk stratification, using EPS in patients displaying a higher risk profile.…”

Section: Phenotypic Characterization and Risk Stratificationmentioning

confidence: 99%

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Compagnucci,

Selimi,

Cipolletta

et al. 2024

JCM

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Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary “sports heart team” evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients’ safety.

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Late potentials in mitral valve prolapse

Cited by 11 publications

References 21 publications

Mitral valve prolapse and sudden cardiac arrest in the community

Mitral valve prolapse and sudden cardiac arrest in the community

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

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

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