Ventricular premature contraction associated with mitral valve prolapse

Hong-TaoYuan,; Yang, Mei; Zhong, Li; Lee, Ying‐Hsiang; Vaidya, Vaibhav R.; Asirvatham, Samuel J.; Ackerman, Michael J.; Pislaru, Sorin V.; Suri, Rakesh M.; Slusser, Joshua P.; Hodge, David O.; Wang, Yu Tang; Cha, Yong‐Mei

doi:10.1016/j.ijcard.2016.06.252

Cited by 33 publications

(30 citation statements)

References 27 publications

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“…This finding argues that multifocality and progression of ComVE, rather than procedural failure, explain the development of malignant arrhythmias in MVP post-index ablation. Our results align with multiple prior studies that have reported multifocal ComVE in MVP [2,9,16,23]. In addition, we demonstrate that induction of sustained VT with standard ventricular pacing maneuvers at index ablation was significantly associated with hemodynamically significant VT/VF requiring repeat procedures.…”

Section: Discussionsupporting

confidence: 90%

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

Marano

Lim

Sánchez

et al. 2020

J Interv Card Electrophysiol

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Purpose Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation, or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation. Methods We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation. Results Over a median follow-up of 3406 (1875-6551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies. Conclusions In the long term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.

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Section: Discussionsupporting

confidence: 90%

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

Marano

Lim

Sánchez

et al. 2020

J Interv Card Electrophysiol

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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 acute success rate of CA varies between studies. The acute success rate for VA in the MVP group was 60% to 94%, depending on the type of VA. Three studies showed that the acute success rate of CA in the non-MVP group was higher than in the MVP group [ 10 , 14 , 15 ]. PM PVCs were less likely to have successful ablation procedures [ 10 , 16 ].…”

Section: Reviewmentioning

confidence: 99%

“…During the follow-up period, three studies reported the recurrence of VAs in MVP and non-MVP groups. Those studies showed that the MVP group had a higher percentage of VAs recurrence compared with the non-MVP group [ 10 , 14 , 15 ].…”

Section: Reviewmentioning

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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2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

Cronin

Bogun

Peichl

et al. 2020

J Interv Card Electrophysiol

112

155

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Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

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Ventricular premature contraction associated with mitral valve prolapse

Cited by 33 publications

References 27 publications

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

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

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

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

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