The Outcome of Ventricular Arrhythmias Associated With Mitral Valve Prolapse After Catheter Ablation: A Systematic Review and Meta-Analysis

Abstract

The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular arrhythmias (VAs) associated with MVP. Despite having high procedural success, outcome data after CA is limited, especially in a long-term setting. Therefore, this systematic review and meta-analysis were performed. Literature searching was conducted in Pubmed, EuropePMC, Proquest, and Ebsco from inception to December 2020 using keywords: ventricular arrhythmia, premature ventricular complex, ventricular tachycardia, ventricular fibrillation, mitral valve prolapse, and catheter ablation. A total of 407 potential articles were retrieved for further review. The final review resulted in six articles for systematic review and meta-analysis. The study was registered in PROSPERO (CRD42020219144). The most common origin of VAs was papillary muscle. The acute success rate of CA in the MVP group varies between 66% and 94%. Follow-up studies reported a higher percentage of VAs recurrence after CA in the MVP group (22.22%) compared with the non-MVP group (11.38%). However, the difference is not significant (P-value = 0.16). Other studies reported a 12.5%-36% rate and 40% of repeat ablation in the medium term and the long term, respectively. Episodes of sudden cardiac death during exertion could still occur following CA in patients with MVP. Distinct origin of VAs was observed during repeated ablation procedures, which may explain arrhythmic substrate progression. Diffuse left ventricular fibrosis around papillary muscle rather than local fibrosis was observed among older patients. Furthermore, the presence of mitral annular disjunction (MAD) and Filamin C mutation might increase the risk of recurrent VAs. CAn has been done as the treatment of VAs associated with MVP. The acute success rate of CA varies between studies and the number of patients requiring repeat CA varied from 12.5% to 40%. Sudden cardiac death could still occur after CA. Older age during CA, genetic predisposition, deep arrhythmic foci, multifocal VAs origin, diffuse fibrosis, and the presence of MAD may contribute to the recurrence of VAs. Further studies, stratification, and evaluation are needed to prevent fatal outcomes in VA associated with MVP, even after CA.

Papillary muscle ventricular ectopy ablation in a malignant mitral valve prolapse

“…8 The most common origin of ventricular arrhythmias is the PM. 9 The acute success rate of catheter ablation in patients in the MVP group varies between Recently, it has been published the expert consensus statement on arrhythmic MVP and MAD complex. 5 Indication for catheter ablation of ventricular arrhythmias is independent of MVP phenotype and may include PVC and VT ablation in patients with symptoms refractory to therapy, to drug treatment, when drug is not tolerated, or when ablation is preferred over long-term drug therapy by patients.…”

“…The acute success rate of catheter ablation in patients in the MVP group varies between 66% and 94% 9 9 . In a series of 15 patients, Marano et al.…”

“…9 Follow-up studies reported a higher percentage of arrhythmia recurrence after ablation in the MVP group compared with the non-MVP group (22.22% vs. 11.38%) 9. In a series of 15…”

"Arrhythmic" Mitral Valve Prolapse

“…Согласно результатам метаанализа исходов желудочковых аритмий после радиочастотной абляции при ПМК, необходимость в повторной процедуре возникала в 12,5-40%. Предрасположенность к рецидивам желудочковых аритмий наблюдали в пожилом возрасте пациентов, в случае генетических особенностей (мутации в гене филамина С), глубоких аритмических очаго в, мультифокального происхождения желудочковой аритмии, диффузного фиброза миокарда и наличия дизъюнкции митрального кольца [39].…”

Mitral valve prolapse: From new mechanisms to diagnostic challenges

“…However, high-risk features such as ventricular arrhythmias, hypercontractility, and fibrosis may prompt further electrophysiologic study investigations [23]. Some authors have considered ablation protocols to relieve the arrhythmia burden with high procedural success, although recurrence of ventricular arrhythmia was not uncommon [35].…”