Arrhythmic Mitral Valve Prolapse: Diagnosis and Treatment

Mitral valve prolapse (MVP) is a common pathology with a population prevalence of 2–3 % (1). This disorder generally has a good prognosis (2), despite the fact that recent observations suggest that sudden cardiac death from ventricular arrhythmias associated with MVP can occur more often, with an estimated annual risk ranging from 0,2 % to 1,9 % (3, 4). Arrhythmic mitral valve pro­lapse is defined as mitral valve prolapse that is associated with complex ventricular arrhythmias (3). Imaging stu­dies of the heart assist in looking for markers that help se­lect patients with a higher risk of fatal arrhythmic events (5). Between 33% and 78% of the patients with malignant ventricular arrhythmias at risk of sudden cardiac death have been found to have an inverted and biphasic T-wave in the inferior and lateral leads. Signs of left ventricular transmural replacement fibrosis in papillary muscles 88% or inferolateral left ventricular basal wall 93% (6) and mitral annular disjunction were also found (7). Surgical repair theoretically relieves stretch on the pa­pillary muscles and facilitates ventricular remodelling, leading to a reduction in ventricular arrhythmias (8). Cat­heter ablation using invasive electroanatomic mapping is a promising treatment option for patients with arrhythmic mitral valve prolapse, but the positive effects on patient survival have not yet been well documented (9). The aim of the study is to review the available literature on the diagnosis and treatment methods of arrhythmic mitral valve prolapse.