Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse

Marano, Paul; Lim, Lisa; Sánchez, José M.; Alvi, Raza M.; Nah, Gregory; Badhwar, Nitish; Gerstenfeld, Edward P.; Tseng, Zian H.; Marcus, Gregory M.; Delling, Francesca N.

doi:10.1007/s10840-020-00775-1

Cited by 32 publications

(60 citation statements)

References 27 publications

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“…One article was excluded because the full text could not be retrieved. The remaining six final articles were included for further analysis in this study [4,10,[14][15][16][17] (…”

Section: Resultsmentioning

confidence: 99%

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

Wibawa¹,

Ivan²,

Jessica³

et al. 2021

Cureus

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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.

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“…One article was excluded because the full text could not be retrieved. The remaining six final articles were included for further analysis in this study [4,10,[14][15][16][17] (…”

Section: Resultsmentioning

confidence: 99%

“…The medium-term and long-term outcomes were available from the included studies [4,10,[14][15][16][17]. During the medium-term, some patients had repeated ablation for VAs.…”

Section: Figure 2: Forest Plot Of Ventricular Arrhythmia Recurrence Between Groupsmentioning

confidence: 99%

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

Wibawa¹,

Ivan²,

Jessica³

et al. 2021

Cureus

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“…13 However, in the long term, RCA of complex VE may not prevent new complex VAs (VT and VF) episodes requiring new ablation procedures and ICD implantation. 45 This is particularly evident in MVP patients with multifocal complex VE during EPS. 45 We can interpret these data by considering the natural evolution of MVP.…”

Section: Electrophysiologic Study and Catheter Ablationmentioning

confidence: 94%

“…45 This is particularly evident in MVP patients with multifocal complex VE during EPS. 45 We can interpret these data by considering the natural evolution of MVP. The more the time passes, the more the mitral leaflets pull, and more fibrosis is formed, leading to multiple new arrhythmic substrates.…”

Section: Electrophysiologic Study and Catheter Ablationmentioning

confidence: 94%

Arrhythmic mitral valve prolapse: Diagnostic parameters for high‐risk patients: A systematic review and meta‐analysis

Oliveri

Fotios

Panday

et al. 2021

Pacing Clinical Electrophis

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Background: Although frequently considered a benign condition, new evidence has shown that mitral valve prolapse (MVP) is associated with complex ventricular arrhythmias (VAs) and sudden cardiac death (SCD). Therefore, we conducted a systematic review and meta-analysis of the relevant studies to investigate the parameters that could identify MVP patients at higher risk of experiencing complex VAs. Method:We performed a systematic literature search of PubMed for potential studies between January 2010 and January 2021. Our meta-analysis included studies comparing MVP patients with complex VAs (A-MVP) and those without (NA-MVP). We used the fixed-effects model to obtain the odds ratio (OR), risk ratio (RR), or mean difference (MD) and 95% confidence interval (CI) for each analyzed parameter.Results: Six studies with 848 individuals were included in the meta-analysis. As compared to the NA-MVP patients, A-MVP patients had a higher prevalence of inverted

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“…Furthermore, a recent study shows that over a median follow-up of 9 years, 33% of patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). This could indicate the progressive characteristics of the arrhythmia in patients with MVP [20].…”

Section: Treatment For Arrhythmic Mitral Valve Prolapsementioning

confidence: 95%

Aborted sudden cardiac death due to ventricular fibrillation in a female patient with mitral valve prolapse

Ayed

Hoffmann

2021

Cardiovasc Ultrasound

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Background Mitral valve prolapse is the most frequent valvular defect associated with a wide range of electro-hemodynamic abnormalities, leading to heart failure, arrhythmias and sudden cardiac death. Mitral valve prolapse, first described from Barlow in the 1960s, is defined as displacement of mitral leaflet tissue into the left atrium past the mitral annular plane during systole. The correlation between mitral valve prolapse and sudden cardiac death has been investigated and clarified by various studies in recent years. However, identifying patients at risk and applying measures to prevent those from sudden cardiac death is challenging. Case presentation We report on a 61-year-old female patient who had undergone an aborted sudden cardiac death. An arrythmogenic mitral valve prolapse was diagnosed. In addition, electrocardiographically and morphologically risk markers for sudden cardiac death were found in this case. We performed an ICD implantation as secondary prophylaxis and intended to reconstruct the mitral valve. Conclusion This article examines the association of mitral valve prolapse with sudden cardiac death, the underlying pathophysiological mechanisms and the strategies leading to identify the risk group.

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Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse

Cited by 32 publications

References 27 publications

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

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

Arrhythmic mitral valve prolapse: Diagnostic parameters for high‐risk patients: A systematic review and meta‐analysis

Aborted sudden cardiac death due to ventricular fibrillation in a female patient with mitral valve prolapse

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