Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Imaging

Background:

• Growing evidence links mitral valve prolapse (MVP) to sudden cardiac death (SCD).
• Identifying at-risk patients is crucial for preventing SCD in MVP.
• Understanding arrhythmia mechanisms in MVP is key for risk stratification.

Purpose of the Study:

• To review the incidence of SCD in MVP patients.
• To outline the clinical profile of patients at increased risk for SCD.
• To discuss the arrhythmogenic substrate and triggers in MVP and potential interventions.

Main Methods:

• Review of reported incidence of SCD in MVP.
• Analysis of clinical risk factors and patient profiles.
• Discussion of electrophysiological substrates and triggers for ventricular arrhythmias.

Main Results:

• Several noninvasive modalities identify MVP patients at higher risk for SCD.
• ECG findings (inferior T-wave inversions), ventricular ectopy, echocardiographic patterns, and cardiac MRI fibrosis are key markers.
• Understanding arrhythmia components (substrate and trigger) is essential.

Conclusions:

• MVP patients with specific risk factors face an elevated risk of SCD.
• Noninvasive diagnostics play a vital role in risk assessment.
• Targeted interventions may benefit MVP patients at highest risk for SCD.