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

Authors
  • Marano, Paul J1
  • Lim, Lisa J1
  • Sanchez, Jose M1
  • Alvi, Raza2
  • Nah, Gregory1
  • Badhwar, Nitish1
  • Gerstenfeld, Edward P1
  • Tseng, Zian H1
  • Marcus, Gregory M1
  • Delling, Francesca N3
  • 1 Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA.
  • 2 Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • 3 Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA. [email protected] , (France)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Jun 01, 2021
Volume
61
Issue
1
Pages
145–154
Identifiers
DOI: 10.1007/s10840-020-00775-1
PMID: 32506159
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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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