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Ventricular arrhythmias and mitral valve prolapse in childhood
Insights
Children with mitral valve prolapse frequently experience ventricular arrhythmias, including potentially serious ventricular premature complexes (VPCs). This study highlights a significant association in pediatric patients, warranting further investigation into clinical implications.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Echocardiography
Background:
- The link between mitral valve prolapse (MVP) and ventricular arrhythmias is established in adults but remains debated in pediatric populations.
- Mitral valve prolapse is a common cardiac condition in children, with potential for associated arrhythmias.
Purpose of the Study:
- To determine the incidence of ventricular premature complexes (VPCs) in children diagnosed with mitral valve prolapse.
- To compare arrhythmia occurrence in children with MVP to a control group.
Main Methods:
- Prospective evaluation of 103 children with echocardiographically confirmed MVP using treadmill exercise and ambulatory ECG.
- A control group of 50 children without MVP underwent similar diagnostic testing.
Main Results:
- Ventricular premature complexes (VPCs) were detected in 16/103 patients during treadmill exercise and 39/103 on ambulatory ECG.
- High-grade ventricular ectopy, including ventricular tachycardia, was observed in 4 patients during exercise and 8 on ambulatory ECG.
- No VPCs were seen in controls during exercise, and only rare uniform VPCs were noted on ambulatory ECG in the control group.
Conclusions:
- Potentially serious ventricular arrhythmias are frequently observed in children with mitral valve prolapse.
- The study demonstrates a significant association between MVP and ventricular arrhythmias in pediatric patients.
- Clinical examination, standard ECG, or symptoms did not correlate with VPCs in this cohort.
Abstract:
Although ventricular arrhythmias are well described in adults with mitral valve prolapse, this association remains controversial in children. To assess the incidence of ventricular premature complexes (VPCs), 103 consecutive children with mitral valve (MV) prolapse confirmed by echocardiography were evaluated prospectively by treadmill exercise and ambulatory ECG. A group of 50 normal children with clinical, ECG, or echocardiographic evidence of heart disease who had undergone treadmill exercise and ambulatory ECG served as controls. In the group with MV prolapse, 16 patients had VPCs with treadmill exercise and 39 had VPCs on ambulatory ECG. High-grade ventricular ectopy (multiform VPCs, couplets, or ventricular tachycardia) was recorded in four patients with MV prolapse during treadmill exercise and in eight during ambulatory ECG. In contrast, no control patient had a single VPC in response to treadmill exercise and only four control patients had rare uniform VPCs on ambulatory ECG. Neither physical examination findings, standard ECG results, nor symptoms could be correlated with VPCs in the patients with MV prolapse. Although the prognostic implications of these findings are uncertain, this study demonstrates that potentially serious ventricular arrhythmias are frequently observed in children with MV prolapse.