Sudden Cardiac Death in Mitral Valve Prolapse.

To the Editor: I read with interest the excellent report on sudden cardiac death with apparently normal heart by Chugh et al.1 Of note was the finding that 28 of 270 hearts (10%) had pathological criteria for mitral valve prolapse. In addressing the association between mitral valve prolapse and sudden cardiac death, the authors classified these hearts as having a nonspecific structural abnormality. Such an assumption is open to question. Evidence to date suggests that the predominant mechanism of sudden cardiac death in mitral valve prolapse is fatal ventricular arrhythmias.2 Therefore, it would be extremely difficult for a pathological study such as that by Chugh et al1 to prove or disprove conclusively the causal relation between mitral valve prolapse and sudden cardiac death. Whether mitral valve prolapse claimed the life of Shylock in the Merchant of Venice, who claimed the heart of Portia’s lover,3 or Antonia in the Tales of Hoffman, who sang herself to death,4 there is no question that although generally a benign condition, mitral valve prolapse may be a deadly disease at times.5 Admittedly, mitral valve prolapse is an uncommon cause of sudden cardiac death,2 and its propensity to cause sudden death has been of major concern mainly because of the high frequency of this abnormality in the general population.5