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Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse

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Abstract

Purpose

Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation, or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation.

Methods

We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation.

Results

Over a median follow-up of 3406 (1875-6551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies.

Conclusions

In the long term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.

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Availability of data

Data are available upon reasonable request.

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Funding

This work was completed with the use of funding provided by National Heart, Lung and Blood Institute R03HL145238 (FND). This source of funding had no role in study design, collection, analysis, interpretation of data, the writing of the report, or the decision to submit for publication.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA

    Paul J. Marano, Lisa J. Lim, Jose M. Sanchez, Gregory Nah, Nitish Badhwar, Edward P. Gerstenfeld, Zian H. Tseng, Gregory M. Marcus & Francesca N. Delling

  2. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Raza Alvi

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  1. Paul J. Marano
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  2. Lisa J. Lim
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Contributions

The authors contributed to this manuscript through conception and design of study (FND, PM), analysis and interpretation of data (PM, GN, FND), drafting of the manuscript (PM, FND), and collection of the data and critical revision of the manuscript for important intellectual content (LJL, JMS, RA, NB, EPG, ZHT, GMM).

Corresponding author

Correspondence to Francesca N. Delling.

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Competing interests

The authors declare that they have no competing interests.

Ethical approval

This retrospective study was approved by the University of California, San Francisco’s Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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Marano, P.J., Lim, L.J., Sanchez, J.M. et al. Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse. J Interv Card Electrophysiol 61, 145–154 (2021). https://doi.org/10.1007/s10840-020-00775-1

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  • DOI: https://doi.org/10.1007/s10840-020-00775-1

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