The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse

Abstract

BackgroundBileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients.MethodsWe included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B).ResultsIn the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04).ConclusionsMV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

“…Ventricular ectopy burden was unchanged after mitral valve surgery. Only younger patients had a greater reduction in ventricular ectopy, suggesting that early surgical intervention could modify the underlying electrophysiologic substrate (29).…”

Escitalopram Induced Torsade de Pointes and Cardiac Arrest in a Patient With Surgically Treated Mitral Valve Prolapse

“…Mitral valve prolapse (MVP) is often associated with a mechanical myocardial and papillary muscle injury and fibrosis that can form a focus from which aberrant electrical potentials can be generated [9]. Furthermore, Naksuk et al showed that mitral valve surgery did not necessarily decrease the burden of ventricular arrhythmias and proposed that the arrhythmogenic substrate formed following longstanding MVP is frequently not reversed by valve replacement surgery [4]. The ECG taken prior to surgical repair in our case, showed frequent ventricular ectopic beats in a pattern of ventricular bigeminy, hinting to the development of an arrhythmogenic focus associated with long term mechanical strain related to MVP.…”

“…Structural heart disease increases the risk of developing an arrhythmia; the presence of mitral valve prolapse (MVP) is associated with an increased risk of ventricular arrhythmias and sudden death. Arrhythmias have been known to persist even after the replacement of the defective valve [4]. Although MVP is known to be arrhythmogenic [5], there is often a trigger that sets off the arrhythmogenic cascade.…”

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

“…Accordingly, the management of a young patient with mitral valve prolapse complaining of atypical chest pain, non specific palpitations or a Holter recording of ventricular premature beats (VPC) continues to engage a major challenge for the practicing physician. Moreover, many of us are aware of MVP patients who were timely diagnosed and apparently well treated but still died in a devastating way resulting from absence of appropriate risk stratification to help the burden of ventricular arrhythmias in patients with bileaflet MVP [18]. Thus, the role of MV surgery to reduce malignant arrhythmia is not conclusive and further studies will be needed before this could be advocated.…”