The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study

Abstract

Objectives Aim of this study was to evaluate arrhythmic burden of patients with Barlow’s disease and significant mitral regurgitation (MR) and assess the impact of mitral repair on ventricular arrhythmias (VA) in this group of subjects. Methods We prospectively included 88 consecutive patients with Barlow’s disease referred to our Institution from February 2021 to May 2022. All enrolled patients underwent 24-hour Holter monitoring before surgery. Sixty-three of them completed 3 months echocardiographic and Holter follow-up. Significant arrhythmic burden was defined as ≥ 1% premature ventricular beats/24 hours or at least one episode of non-sustained ventricular tachycardia (VT), VT or ventricular fibrillation. Results At baseline, 29 patients (33%) were arrhythmogenic (AR) while 59 (67%) were not (NAR). AR subjects tended to be more often females with history of palpitations. Sixty-three patients completed 3-months follow-up. Twenty of them (31.7%) were AR at baseline and 43 (68.3%) were not. Among AR patients, 9 (45%) remained AR after mitral surgery, while 11 (55%) became NAR. Considering NAR subjects at baseline, after mitral valve repair 8 (18.6%) evolved into AR, while 35 (81.4%) remained NAR. A higher prevalence of pre-operative MAD was found among patients experiencing VA reduction if compared with patients who remained arrhythmogenic (63.6% vs 11.1%, p = 0.028). Conclusions In our experience, 1/3 of Barlow’s patients referred for mitral surgery showed a significant arrhythmic burden. Almost half of the subjects arrhythmogenic at baseline were free from significant VA after mitral repair. However, a minority (18.6%) of subjects without arrhythmic burden at baseline experienced significant VA at follow-up.

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

“…Theoretically, MV repair may eliminate MAD, and interrupt the maladaptive mechanical process underpinning papillary muscle/inferolateral fibrosis [ 5 , 62 ]; furthermore, the cryoablation of VAs may be performed during surgical MV repair [ 5 ]. However, a recent case series reported that although MV surgery resulted in a reduction in VA burden in 55% of AMVP patients, 19% of patients without VAs prior to MV repair developed complex VAs during follow-up, warranting continued surveillance [ 114 ]. Return to play after successful MV repair should be evaluated on a case-by-case basis, in the absence of residual moderate/severe MR, LV dysfunction, and arrhythmias at 24 h Holter monitoring and maximal exercise stress testing [ 61 , 62 ].…”