Author + information
- Joseph Bumgarner,
- Joshua Clevenger,
- Brian Griffin,
- Mohamed Kanj,
- Venu Menon and
- Vidyasagar Kalahasti
Background: Mitral Valve Prolapse (MVP) is reported in otherwise healthy subjects experiencing sudden cardiac death (SCD). Multiple studies propose ventricular automaticity (VA) as the mechanism of death in these patients. The baseline characteristics, management, and outcomes of patients with isolated MVP who experience VA have not been described.
Methods: We performed a retrospective study of adult patients with isolated MVP who underwent VT/PVC ablation or secondary prevention ICD implantation at our institution from Jan97- Jul 16. Patients with prior ICD implantation were excluded. Patient characteristics, ECGs, echocardiograms, and EP study data were analyzed.
Results: A total of 43 patients (20 Male) with MVP and significant VA (VT or a significant PVC burden) underwent either ablation or ICD placement. Overall, 13 patients underwent secondary prevention ICD placement and 30 underwent PVC or VT ablation. A history of SCD was present in 9 patients.
Echo data revealed 59% (n = 31) had moderate mitral regurgitation (2+ or greater) due to MVP. Both MV leaflets were most commonly involved (n = 22, 52%) with posterior MVP being the next most common (n = 15, 36%). The LVEF of the total population was 57% (±5.9%). Of patients with SCD, 78% had moderate to severe MR (n = 7).
The etiology of VA was VT (n = 21, 49 %), symptomatic PVCs (n = 21, 49%) and one patient experienced VF. VA was most commonly localized to the left ventricle (n = 19, 66%). The most common foci for ventricular arrhythmias were the left ventricular papillary muscle (n = 9, 27%), MV annulus (n = 5, 15%), right ventricular outflow tract (n = 5, 15%) and LV apex (n = 4, 12%). Ablation was successful in 65% of cases (n = 20) and partially successful in 19% of cases (n = 6). At a mean follow-up of 2.5 years, 26% had recurrent VT (n = 11). Of patients who underwent ICD placement, a total of 9 patients had documented non-sustained VT (56%), 2 patients had ATP delivered (13%) and 2 were internally defibrillated (13%).
Conclusions: Patients with isolated MVP and VA were more likely to have bileaflet prolapse and at least moderate mitral regurgitation with preserved LVEF. VA originated more commonly from left-sided foci, and ablation was successful in the majority of cases.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-103
- 2017 American College of Cardiology Foundation