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Journal of Interventional Cardiac Electrophysiology

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01-06-2021 | Ventricular Tachycardia | MULTIMEDIA REPORT

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

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

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2021

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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Title: Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse
Authors: Paul J. Marano
Lisa J. Lim
Jose M. Sanchez
Raza Alvi
Gregory Nah
Nitish Badhwar
Edward P. Gerstenfeld
Zian H. Tseng
Gregory M. Marcus
Francesca N. Delling
Publication date: 01-06-2021
Publisher: Springer US
Keywords: Ventricular Tachycardia
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2021
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-020-00775-1

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