Arrhythmic Mitral Valve Prolapse Detection Using Long-term Ambulatory Rhythm Monitoring

Summary

Mitral valve prolapse (MVP) affects up to 3% of the general population and a small subset of patients is at risk for ventricular arrhythmias. This subgroup is referred to as AMVP (arrhythmic MVP) and was recently defined using the following criteria: (1) Presence of MVP), (2) Ventricular arrhythmia that is either frequent (≥5% total premature ventricular contraction (PVC) burden on Holter) or complex (non-sustained ventricular tachycardia (nsVT), ventricular tachycardia (VT), or ventricular fibrillation (VF)), and (3) The absence of any other well-defined arrhythmic substrate. Currently, diagnosis is often based on repeated 24-hour Holter monitoring. However, the ventricular arrhythmia burden varies from day-to-day and long-term rhythm monitoring has shown in other pathologies to increase the diagnostic yield with up to 200% (from 22.5% on 24h to 75.3% on 14 days). This pilot study aims to study the diagnostic yield of long-term rhythm monitoring in patients with MVP as well as the day-to-day variability of ventricular arrhythmias to facilitate power calculation for a future large-scale prospective registry.

Eligibility

Inclusion Criteria:

* Patients aged 18 years or older
* Mitral valve prolapse diagnosed on previous echocardiography or cardiac MRI
* New York Heart association classification ≥3 for cohort 3 and classification 1 or 2 for cohorts 1 and 2
* Willing and able to provide signed written informed consent
* No contra-indication for long-term monitoring (known allergy to adhesives)

Exclusion Criteria:

* Prior cardiac surgery, including previous mitral valve intervention
* Prior endovascular mitral valve repair (MitraClip)
* Previous catheter ablation of ventricular arrhythmias
* Patients not in sinus rhythm
* Patients on anti-arrhythmic drugs but betablockers
* Known alternative arrhythmic substrate, for example previous myocardial infarction
* Known allergy to adhesives

Conditions3

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