Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse

Sniezek-Maciejewska, M; Jp, Dubiel; Piwowarska, W; Mroczek-Czernecka, D.; Mazurek, Suzanne Nodop; Jaśkiewicz, Jerzy; Kitliński, Mariusz

doi:10.1002/clc.4960151029

Cited by 25 publications

(16 citation statements)

References 31 publications

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“…These contact lesions may predispose to fibrotic change but may also serve to trigger premature contractions resulting in ventricular arrhythmias . As such, the predisposition to arrhythmia in certain MVP patients appears to stem from a combination of mechanical effects triggering premature beats and abnormal substrate related fibrosis . To our knowledge, however, the detailed electrophysiological mechanisms underlying such arrhythmias in BiMVP have not been reported.…”

Section: Discussionmentioning

confidence: 96%

Bileaflet Mitral Valve Prolapse and Risk of Ventricular Dysrhythmias and Death

Nordhues

Siontis

Scott

et al. 2016

Cardiovasc electrophysiol

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Although BiMVP is associated with ventricular tachycardia, it is not associated with an increased risk of cardiac arrest/ventricular fibrillation or ICD implantation and is, paradoxically, associated with a better survival compared to SiMVP or matched controls. The findings suggest that, despite its association with ventricular tachycardia, BiMVP in the absence of other risk factors does not seem to portend a poor prognosis at the population level.

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Section: Discussionmentioning

confidence: 96%

Bileaflet Mitral Valve Prolapse and Risk of Ventricular Dysrhythmias and Death

Nordhues

Siontis

Scott

et al. 2016

Cardiovasc electrophysiol

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“…Further, QT dispersion was found to be related to the degree of prolapse and leaflet thickness, providing a mechanical correlation for electrical disturbances in MVP 22 . A role for increased autonomic tone has been proposed with relatively higher catecholamine excretion in MVP patients with ventricular arrhythmia 23 . Wilde and colleagues performed detailed mapping studies on a patient with MVP and VT and concluded that delayed afterdepolarization-induced triggered activity was the mechanism, with stretch and fibrosis of the papillary muscles contributing to the origin of the arrhythmia 24 .…”

Section: Discussionmentioning

confidence: 99%

Mitral valve prolapse and sudden cardiac arrest in the community

et al. 2016

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Background Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, the association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial. Objective To ascertain the frequency of MVP among SCA cases in the community and characterize the clinical profile of SCA cases with MVP Methods SCA cases were prospectively identified in the population-based, Oregon Sudden Unexpected Death Study (population approximately 1 million). Presence of MVP was identified from echocardiograms performed prior but unrelated to the SCA event. The detailed clinical profile of SCA cases with MVP was compared to those without MVP to identify potential differences. Results 729 SCA cases were evaluated over a 12 year period (69.5 ± 14.8 years; 64.6% male). MVP was seen in 17 cases pre-arrest (2.3%; 95% CI 1.2 to 3.4%). Mitral regurgitation (MR) was present in 14 (82.3%) MVP-SCA cases, and was moderate or severe in 10 (58.8%). Compared to cases without MVP, MVP-SCA cases were younger (60.9 ± 16.4 vs 69.7 ± 14.7; p=0.02), with fewer risk factors (diabetes 5.9% vs 46.4%; p=0.001; hypertension 41.2% vs 78.9%; p=0.001) or known coronary disease (29.4% vs 65.6%; p<0.001). Conclusion MVP was observed in a small proportion (2.3%) of SCA cases in the general population, suggesting a low risk overall. Since MVP-SCA cases were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency, as well as genetics could aid future risk stratification approaches.

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“…Increased autonomic tone is another proposed mechanism of ventricular arrhythmias, as are abnormal catecholamine regulation, increased catecholaminergic state, and baroreflex modulation in patients with MVP [27,28]. Previous studies have shown increased catecholaminergic activity to be associated with repolarization abnormalities and ventricular arrhythmias [9]. Several reports showed alterations in ventricular repolarization, such as increased QT and QTc dispersions, in MVP patients [29,30].…”

Section: Discussionmentioning

confidence: 97%

“…The exact mechanisms causing ventricular arrhythmias remain elusive. Structural abnormalities of the mitral valve leading to mechanical triggering and abnormalities of the autonomic nervous system are considered to be the underlying conditions of ventricular arrhythmias [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Prolonged Tp–e Interval and Tp–e/QT Ratio in Children with Mitral Valve Prolapse

et al. 2016

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Although it is considered to be a benign condition, previous studies have shown that a subset of patients with mitral valve prolapse (MVP) may be at risk of ventricular arrhythmia and sudden cardiac death (SCD). Previous studies have suggested that the interval between the peak and the end of the T wave (Tp-e) can be used as a marker for the transmural dispersion of repolarization. Increased Tp-e interval and Tp-e/QT ratio are associated with ventricular arrhythmias and SCD. The aim of this study was to assess alterations in ventricular repolarization by using the Tp-e interval and Tp-e/QT ratio in children with MVP and to investigate their relationships with the degree of valvular regurgitation. This study prospectively investigated 110 children with MVP and 107 age- and sex-matched healthy control subjects. Tp-e interval, Tp-e/QT ratio, and QT and QTc dispersions were measured from a 12-lead electrocardiogram and compared between groups. QT and QTc dispersions, Tp-e interval, and Tp-e/QTc ratio were found to be significantly higher in patients with MVP. A positive correlation was found between Tp-e/QTc ratio and increase in the degree of mitral regurgitation (MR) (p < 0.05; r = 0.2). However, the degree of MR was not associated with QT, QTc, or Tp-e intervals; QT, QTc, or Tp-e dispersions; or Tp-e/QT ratio (all p values >0.05). Individuals with MVP may be more prone to ventricular arrhythmias due to prolonged QTd, QTcd, and Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios. Therefore, due to their longer life expectancy, children with MVP should be followed up on regarding life-threatening arrhythmias.

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Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse

Cited by 25 publications

References 31 publications

Bileaflet Mitral Valve Prolapse and Risk of Ventricular Dysrhythmias and Death

Bileaflet Mitral Valve Prolapse and Risk of Ventricular Dysrhythmias and Death

Mitral valve prolapse and sudden cardiac arrest in the community

Prolonged Tp–e Interval and Tp–e/QT Ratio in Children with Mitral Valve Prolapse

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