Arrhythmogenic Mitral Valve Prolapse: Can We Risk Stratify and Prevent Sudden Cardiac Death?

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Surgery

Background:

• Mitral valve prolapse (MVP) is increasingly recognized as a cause of ventricular arrhythmias and sudden cardiac death (SCD).
• This phenomenon, termed 'malignant MVP', can occur even without significant mitral regurgitation, suggesting complex interactions between valve mechanics and left ventricular function.
• Effective risk stratification is essential for managing patients at risk of SCD.

Purpose of the Study:

• To review arrhythmogenic mitral valve prolapse (MVP).
• To explore epidemiology, clinical presentation, mechanisms, and management strategies for MVP-associated arrhythmias.
• To discuss the importance of risk stratification for preventing sudden cardiac death (SCD).

Main Methods:

• Review of existing literature on arrhythmogenic mitral valve prolapse (MVP).
• Analysis of epidemiological data, clinical presentations, and proposed mechanisms linking MVP to sudden cardiac death (SCD).
• Evaluation of diagnostic modalities including patient history, physical examination, electrophysiological studies, and imaging.

Main Results:

• Ventricular arrhythmias and sudden cardiac death (SCD) are rare but recognized complications of mitral valve prolapse (MVP).
• The risk of SCD in MVP patients may not correlate with the severity of mitral regurgitation.
• Clinical, imaging, and electrophysiological data are used for risk stratification, but defining a clear high-risk profile remains challenging.

Conclusions:

• Arrhythmogenic mitral valve prolapse (MVP) is a significant concern, necessitating comprehensive evaluation and risk stratification.
• Accurate risk assessment is vital for guiding interventions, such as implantable cardioverter-defibrillator (ICD) placement, for primary prevention of sudden cardiac death (SCD).
• Further research is needed to optimize the integration of clinical, imaging, and electrophysiological data for precise risk stratification in MVP patients.