Arrhythmogenic mitral valve prolapse and mitral annular disjunction: a literature review and case-based perspective

Mitral valve prolapse (MVP) is among the most frequently diagnosed valvular heart diseases, with the majority of patients being asymptomatic. However, MVP may also present with ventricular arrhythmias (VA) or sudden cardiac death (SCD). The arrhythmic form of MVP and the complicated course of this condition are closely associated with mitral annular disjunction (MAD). MAD alters the anatomical integrity of the mitral annulus and is thought to contribute to leaflet degeneration and myocardial fibrosis, creating a substrate for malignant arrhythmias. The most common complications associated with MVP and MAD include progressive mitral valve regurgitation, left ventricular hypertrophy and an increased risk of SCD. Cardiac magnetic resonance (CMR) imaging is the most sensitive modality for detecting MAD and myocardial fibrosis and is thus essential for early diagnosis and risk stratification. This review aims to enhance recognition of MAD, summarize current diagnostic and risk assessment strategies, and provide clinical context through two cases of patients with arrhythmic MVP and MAD.