Bileaflet mitral valve prolapse was significantly associated with ventricular fibrillation recurrences requiring ICD therapy (OR 7.2; 95% CI 1.1-48; p=0.028) in patients with idiopathic cardiac arrest.
Cohort (n=24)
No
Does bileaflet mitral valve prolapse increase the risk of recurrent ventricular fibrillation in patients with idiopathic out-of-hospital cardiac arrest?
Bileaflet mitral valve prolapse identifies a malignant phenotype associated with life-threatening ventricular arrhythmias and recurrent ventricular fibrillation in patients with otherwise idiopathic out-of-hospital cardiac arrest.
Odds Ratio: 7.2 (95% CI 1.1–48)
p-value: p=0.028
OBJECTIVES: The aim of this study was to investigate the prevalence of mitral valve prolapse (MVP) and its association with ventricular arrhythmias in a cohort with "unexplained" out-of-hospital cardiac arrest. BACKGROUND: Ventricular arrhythmias are an important cause of sudden unexpected death in the young. The role of MVP in sudden unexpected death remains controversial. METHODS: Of 1,200 patients evaluated between July 2000 and December 2009 in the Mayo Clinic's Long QT Syndrome/Genetic Heart Rhythm Clinic, all 24 (16 women, median age 33.5 years) with idiopathic out-of-hospital cardiac arrest (i.e., negative for ischemia, cardiomyopathy, and channelopathy) were reviewed. RESULTS: All 24 patients had implantable cardioverter-defibrillators (ICDs). Out-of-hospital cardiac arrest was the sentinel event in 22 (92%). Bileaflet MVP was found in 10 (42%). Compared with patients with normal mitral valves, patients with bileaflet MVP: 1) were over-represented by women (9 of 10 90% vs. 7 of 14 50%, p = 0.04); 2) had a higher prevalence of biphasic or inverted T waves (7 of 9 77.8% vs. 4 of 14 29%, p = 0.04); and 3) on Holter interrogation had higher prevalence of ventricular bigeminy (9 of 9 100% vs. 1 of 10 10%, p < 0.0001), ventricular tachycardia (7 of 9 78% vs. 1 of 10 10%, p = 0.006), and premature ventricular contractions originating from the outflow tract alternating with the papillary muscle or fascicular region (7 of 9 78% vs. 2 of 10 20%, p = 0.02). Over a median 1.8 years (range: 0.1 to 11.9 years) from ICD placement, 13 of 24 patients (54%) received appropriate ventricular fibrillation-terminating ICD shocks. Only bileaflet MVP was associated with ventricular fibrillation recurrences requiring ICD therapy on follow-up (logistic regression odds ratio: 7.2; 95% confidence interval: 1.1 to 48; p = 0.028). CONCLUSIONS: The authors describe a "malignant" subset of patients with MVP who experienced life-threatening ventricular arrhythmias. This phenotype is characterized by bileaflet MVP, female sex, and frequent complex ventricular ectopic activity, including premature ventricular contractions of the outflow tract alternating with papillary muscle or fascicular origin.
“"Malignant" MVP was coined after a 2013 study showed 10 of 22 patients with unexplained SCD had BiMVP.”
Sriram et al. (Thu,) conducted a cohort in Idiopathic out-of-hospital cardiac arrest (n=24). Bileaflet mitral valve prolapse vs. Normal mitral valves was evaluated on Ventricular fibrillation recurrences requiring ICD therapy (OR 7.2, 95% CI 1.1-48, p=0.028). Bileaflet mitral valve prolapse was significantly associated with ventricular fibrillation recurrences requiring ICD therapy (OR 7.2; 95% CI 1.1-48; p=0.028) in patients with idiopathic cardiac arrest.