Mitral valve surgery: Does it really decrease ventricular arrhythmia in patients with mitral valve prolapse?

Mitral valve (MV) prolapse (MVP) is characterized by fibromyxomatous changes in themitral leaflet tissue, with superior displacement of one or both leaflets into the left atrium. It is not an uncommon finding on echocardiographic screening, afflicting 2e3% of the general population, though most of them remain asymptomatic [1e3]. MVP can be distinguished into primary (nonsyndromic) and secondary (syndromic) MVP. Secondary MVP occurs in the presence of connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, and aneurysms-osteoarthritis syndrome. MVP has also been observed in hypertrophic cardiomyopathy (HCM) and may contribute to the pathophysiology of obstruction [1]. MVP is generally regarded as a benign condition [4e6], however, the outcome is widely heterogeneous, and its manifestations such asmitral regurgitation (MR), atrial fibrillation, congestive heart failure, endocarditis, and stroke are well known. Cardiac mortality is best predicted by the presence of mitral regurgitation (MR) and left ventricular dysfunction at the time of diagnosis. Risk factors for cardiac morbidity include age 50 years, left atrial enlargement, MR, the presence of a flail leaflet, and atrial fibrillation [4,7e11]. MR can occur due to a spectrum ranging from single prolapsing valve segment to diffuse myxomatous degeneration with bileaflet prolapse and annular dilatation. Degenerative mitral valve disease, most commonly related to MVP, is the most repairable form of surgical mitral valve disease, and repair is the most recommended surgical approach and represents 60e70% of surgical mitral regurgitation (MR) in industrialized nations [12e15]. Cardiac arrhythmias are frequently detected in patients with mitral valve prolapse (MVP) [16,17]. Atrial ectopics, couplets, atrial tachycardia, paroxysmal or sustained atrial flutter or fibrillation as well as ventricular premature contractions (VPCs), multiform VPC, VPC couplets, and runs of three or more sequential VPCs (salvos of