Mitral valve prolapse in sudden cardiac arrest survivors - coincidence or causal relationship?

Background: Sudden cardiac arrest (SCA) risk stratification in patients with mitral valve prolapse (MVP) may be complicated by other potential causes of arrhythmia.

Objectives: We aimed to characterize SCA survivors with isolated (iMVP) and non-isolated MVP (non-iMVP) and to assess their long-term follow-up.

Methods: This ambispective study included 75 patients with MVP who experienced SCA and were treated in our center between 2009-2024. They were divided into three groups depending on probability of relation between SCA and comorbidities. The control group comprised 112 subjects with MVP but without a history of SCA. We analyzed all available electrocardiograms, Holter ECG monitoring and echocardiograms, including longitudinal strain. A novel parameter, the systolic atrial-directed notch (SADN) was tested.

Results: SCA survivors with iMVP (n=28) had higher prevalence of mitral annular disjunction (MAD) (80% vs. 35.7%, P=0.006), Pickelhaube sign (60% vs. 8.3%, P=0.008), SADN > 2 mm (69.6% vs. 14.3%, P=0.001) as well as higher absolute longitudinal strain values in basal and mid segments of inferior and inferolateral wall than patients with SCA and non-iMVP without other defined structural heart diseases (SHD(-)) (n=14). The differences were also observed in comparison to control group. The cumulative incidence of appropriate implantable cardioverter-defibrillator shocks within 6 years was 62% in patients with iMVP and 23% in the group with non-iMVP SHD(-).

Conclusions: Echocardiographic findings such as MAD, SADN, Pickelhaube sign and increased segmental strain may be useful in the assessment of relation between SCA and MVP. Malignant arrhythmias often recur in SCA survivors with iMVP.