Risk factors of ventricular arrhythmias in non-syndromic mitral valve prolapse

Abstract

Non-syndromic mitral valve prolapse (MVP) is a common disease. In most cases, its benign course is noted, however, a connection between MVP and ventricular arrhythmias is reported, as well as sudden cardiac death. Clinical signs (chest pain, syncope/lipotymia, mid-systolic click), results of instrumental studies (electrocardiographic, echocardiographic, magnetic resonance imaging) allow us to identify known ("old") risk factors and new phenomena encountered in rhythm and conduction disturbances during MVP. Signs of "arrhythmic" MVP, often detected in young women, include prolapse of thickened both mitral valve leaflets, T wave inversion in the inferior basal leads on the electrocardiogram, annulus fibrosus disjunction, fibrosis of the papillary muscles and myocardium in the inferior basal wall of the left ventricle, determined by magnetic resonance imaging. resonance tomography and myocardial biopsies. In 2022, the European Heart Rhythm Association Expert Consensus presented risk stratification and treatment principles for patients with arrhythmic MVP, identifying low, intermediate and high-risk groups, and in 2024, the first meta-analysis of studies was performed to identify prognostic risk factors of arrhythmic MVP. The most significant predictors of arrhythmias included late gadolinium enhancement on magnetic resonance imaging, T-wave inversion on the electrocardiogram, prolapse of both mitral valve leaflets, and mitral annulus disjunction. When choosing treatment for patients with arrhythmic MVP, clinical characteristics are taken into account and a personalized approach is used to prevent sudden cardiac death and severe ventricular arrhythmias. As a rule, to prevent sudden cardiac death in patients with arrhythmic MVP, four treatment options are considered: medications (beta-blockers or non-dihydropyridine slow calcium channel blockers, a combination of a beta-blocker and flecainide, or amiodarone), radiofrequency ablation, surgical treatment of the mitral valve, implantable cardioverter — defibrillator (for primary or secondary prevention of sudden cardiac death).The rationale for surgical, electrophysiological, and/or therapeutic treatments depends on the specific rhythm disorder.