Key result
Combined ICD, mitral valve repair, and cryoablation eliminates ventricular arrhythmias at 1 year in arrhythmogenic MVP.
Why the study?
Mitral valve prolapse is typically evaluated by mitral regurgitation severity, but some patients exhibit an arrhythmogenic phenotype associated with life-threatening ventricular arrhythmias requiring early identification and risk stratification.
Case Report (n=1)
This case illustrates the critical need to identify an arrhythmogenic phenotype in mitral valve prolapse using multimodality imaging and prompt aggressive risk stratification even in functionally asymptomatic patients.
Supports combined ICD, repair, and ablation in select arrhythmogenic mitral valve prolapse; leaves open prospective validation before broader adoption.
BACKGROUND: Mitral valve prolapse (MVP) is usually evaluated through the severity of mitral regurgitation (MR), yet some patients may exhibit an arrhythmogenic phenotype associated with life-threatening ventricular arrhythmias. CASE SUMMARY: A 70-year-old asymptomatic woman with Barlow disease was referred for MR reassessment. Echocardiography showed bileaflet prolapse, moderate to severe MR, mitral annular disjunction, and left-sided chamber remodeling. Ambulatory electrocardiographic monitoring revealed frequent polymorphic premature ventricular complexes. Before work-up completion, she experienced an out-of-hospital ventricular fibrillation with cardiac arrest. Cardiac magnetic resonance demonstrated inferolateral myocardial fibrosis. She underwent implantable cardioverter-defibrillator placement, followed by mitral valve repair and surgical ablation. DISCUSSION: This case highlights the need to identify arrhythmogenic MVP early, using an integrated clinical, electrocardiographic, echocardiographic, and cardiac magnetic resonance approaches for individualized risk stratification. TAKE-HOME MESSAGE: In patients with MVP, arrhythmic risk stratification should go beyond MR severity, integrating red flags with clinical assessment, serial multimodality imaging, and a multidisciplinary team involving imaging, electrophysiology, and surgical expertise.
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Ribeyrolles et al. (2026) conducted a case report in Arrhythmogenic Mitral Valve Prolapse (n=1). Implantable cardioverter-defibrillator placement, mitral valve repair, and surgical ablation was evaluated. Implantable cardioverter-defibrillator placement combined with mitral valve repair and surgical ablation successfully treated a 70-year-old woman with arrhythmogenic mitral valve prolapse, resulting in no ventricular arrhythmia episodes at 1-year follow-up.
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