Ventricular arrhythmias and sudden cardiac death caused by mitral valve prolapse: should we operate and when?

Abstract Background Several autopsy and observational studies have investigated the link between mitral valve prolapse (MVP) sudden cardiac death (SCD) due to well accepted yet rare occurrence of complex ventricular arrhythmia (VA) in this cohort. Few however whether burden more importantly SCD are reduced following surgical correction MVP. Purpose To investigate impact surgery (MVS) (replacement or repair) on VA patients with Methods A systematic review current literature was conducted using an electronic search PubMed database October 2021. Studies were included if subjects had undergone (MV) repair replacement documented rates arrythmias/SCD pre- post-intervention. Small patient numbers individual reports precluded formal meta-analysis results reported a per study basis. Results 19 identified (10 cohort studies, nine case studies) comprised 1322 pooled mean age 63.4 years 38.9% female. 748 underwent MVS: 263 MV repair, 18 (one leaflet papillary muscle excision), two Maze procedure, 177 percutaneous transcatheter 45 annuloplasty without 243 cases method not specified. Of 10 seven eight which post MVS concluded there significant reduction, while one predisposition arrythmia persisted after relieving abnormal mechanical effects non-ischaemic MR (75% MVP). One reduction MVS. Each showed annular disjunction (MAD) independently associated higher risk arrhythmic events, persisting time dependent although compared medical management. Conclusions The underlying mechanisms for MVP completely understood, guidelines based lacking. This illustrates possible Further identification at SCD, potential use stratification algorithms, would allow consideration earlier management appropriate implantable cardioverter-defibrillators (ICD) placement / expected survival benefit. Funding Acknowledgement Type funding sources: None.