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Multicenter Study
. 2024 May 31;25(6):764-770.
doi: 10.1093/ehjci/jeae054.

Mitral annular disjunction in idiopathic ventricular fibrillation patients: just a bystander or a potential cause?

L M Verheul  1 , M Guglielmo  1 , S A Groeneveld  1 , F P Kirkels  1 , C Scrocco  2   3 , M J Cramer  1 , M Bootsma  4 , G F L Kapel  5 , M Alings  6 , R Evertz  7 , B A Mulder  8 , N H J Prakken  8 , J C Balt  9 , P G A Volders  10 , A Hirsch  11 , S C Yap  11 , P G Postema  12   13 , R Nijveldt  7 , B K Velthuis  1 , E R Behr  2   3 , A A M Wilde  12   13 , R J Hassink  1
Affiliations
Multicenter Study

Mitral annular disjunction in idiopathic ventricular fibrillation patients: just a bystander or a potential cause?

L M Verheul et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Previously, we demonstrated that inferolateral mitral annular disjunction (MAD) is more prevalent in patients with idiopathic ventricular fibrillation (IVF) than in healthy controls. In the present study, we advanced the insights into the prevalence and ventricular arrhythmogenicity by inferolateral MAD in an even larger IVF cohort.

Methods and results: This retrospective multi-centre study included 185 IVF patients [median age 39 (27, 52) years, 40% female]. Cardiac magnetic resonance images were analyzed for mitral valve and annular abnormalities and late gadolinium enhancement. Clinical characteristics were compared between patients with and without MAD. MAD in any of the 4 locations was present in 112 (61%) IVF patients and inferolateral MAD was identified in 24 (13%) IVF patients. Mitral valve prolapse (MVP) was found in 13 (7%) IVF patients. MVP was more prevalent in patients with inferolateral MAD compared with patients without inferolateral MAD (42 vs. 2%, P < 0.001). Pro-arrhythmic characteristics in terms of a high burden of premature ventricular complexes (PVCs) and non-sustained ventricular tachycardia (VT) were more prevalent in patients with inferolateral MAD compared to patients without inferolateral MAD (67 vs. 23%, P < 0.001 and 63 vs. 41%, P = 0.046, respectively). Appropriate implantable cardioverter defibrillator therapy during follow-up was comparable for IVF patients with or without inferolateral MAD (13 vs. 18%, P = 0.579).

Conclusion: A high prevalence of inferolateral MAD and MVP is a consistent finding in this large IVF cohort. The presence of inferolateral MAD is associated with a higher PVC burden and non-sustained VTs. Further research is needed to explain this potential interplay.

Keywords: cardiac magnetic resonance; idiopathic ventricular fibrillation; mitral annular disjunction; mitral valve prolapse; ventricular arrhythmias.

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Conflict of interest statement

Conflict of interest: A.H. received a research grant and consultancy fees from GE Healthcare and speaker fees from GE Healthcare and Bayer. He is also a member of the medical advisory board of Medis Medical Imaging Systems and was MRI corelab supervisor of Cardialysis BV until 2022. E.R.B. has consulted for Boston Scientific. S.C.Y. is a consultant for Boston Scientific and has received lecture fees and research grants from Medtronic, Biotronik, and Boston Scientific. The other authors have no conflicts of interest to disclose

Figures

Graphical Abstract
Graphical Abstract
ICD, implantable cardioverter defibrillator; ilMAD, inferolateral mitral annular disjunction; PVC, premature ventricular complex; NSVT, non-sustained ventricular tachycardia.
Figure 1
Figure 1
Measurement of MAD and MVP on a 3-chamber view. Red arrow represents the measurement of MAD, white arrows represent the measurement of MVP. MAD, mitral annular disjunction; MVP, mitral valve prolapse.
See this image and copyright information in PMC

Comment in

References

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