Arrhythmic complications of mitral valve prolapse
- Matthew J Sorrentino, MD, FACC
Matthew J Sorrentino, MD, FACC
- Professor of Medicine
- Pritzker School of Medicine of the University of Chicago
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- UT Southwestern Medical Center
Mitral valve prolapse (MVP) is the most common cause of primary mitral regurgitation (MR) in developed countries. The diagnosis is usually suspected from cardiac auscultation and then confirmed by echocardiography. (See "Definition and diagnosis of mitral valve prolapse".)
Although the correlation between certain nonspecific symptoms and MVP remains unclear, many patients with this disorder present with palpitations and atrial or ventricular arrhythmias [1-5]. Some studies suggest that these patients are at increased risk of sudden cardiac death (SCD) compared with the general population, but the exact incidence is unknown. Furthermore, since atrial and ventricular arrhythmias are common in the general population, it is not clearly established that the incidence of arrhythmias and SCD are in fact increased in patients with MVP.
This topic will review the incidence of arrhythmias, the risk of SCD, the electrocardiographic abnormalities that can be seen, and the treatment of arrhythmias in patients with MVP. The nonarrhythmic complications of MVP, including nonspecific symptoms and major complications, such as infective endocarditis, MR, transient ischemic attacks, and cerebrovascular accidents, are discussed separately. (See "Nonarrhythmic complications of mitral valve prolapse" and "Mitral valve prolapse syndrome".)
PREVALENCE OF ARRHYTHMIAS
Several studies report a broad range in incidence of the arrhythmias in patients with mitral valve prolapse (MVP) [1-5]:
●Atrial premature beats – 35 to 90 percent
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- PREVALENCE OF ARRHYTHMIAS
- SUDDEN CARDIAC DEATH
- Risk stratification
- Flail mitral leaflet
- ELECTROCARDIOGRAPHIC ABNORMALITIES
- ELECTROPHYSIOLOGIC TESTING
- Survivors of SCD or sustained VT
- Very symptomatic palpitations
- Mild palpitations from atrial or ventricular premature beats
- Atrial fibrillation
- Asymptomatic patients without evidence of sustained arrhythmias
- Mitral valve surgery
- Participation in sports
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS