Mitral valve prolapse: arrhythmic risk during pregnancy and postpartum

Area of Science:

• Cardiology
• Reproductive Health
• Genetics

Background:

• Arrhythmic Mitral Valve Prolapse (AMVP) is associated with life-threatening ventricular arrhythmias (VAs).
• Young women with AMVP are considered at high risk for VAs.
• Previous cases suggest a link between AMVP, malignant VA, and pregnancy, but the specific risk during pregnancy remains unclear.

Purpose of the Study:

• To describe characteristics of high-risk women with AMVP who experienced malignant VA during the perinatal period.
• To evaluate if pregnancy and the postpartum period increase the risk of malignant VA in these women.

Main Methods:

• Retrospective international multi-center case series.
• Included high-risk women with AMVP and at least one pregnancy who experienced malignant VA (ventricular fibrillation, sustained ventricular tachycardia, or appropriate ICD shock).
• Compared incidence of malignant VA during the perinatal period (pregnancy and 6 months postpartum) versus non-pregnant periods.

Main Results:

• 18 women with AMVP from 11 centers were included.
• 37 malignant VAs occurred during 7.5 years follow-up; 18 were pregnancy-related in 13 patients.
• Incidence rate of malignant VA was higher in the perinatal period compared to non-pregnant periods (IRR 2.66).

Conclusions:

• The perinatal period may increase the risk of malignant VA in women with high-risk AMVP.
• Findings can inform pre-conception counseling and shared decision-making for patients and clinicians.
• Further research is needed to understand the mechanisms and optimize management.