Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 27;13(5):1350.
doi: 10.3390/jcm13051350.

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Paolo Compagnucci  1 , Adelina Selimi  1   2 , Laura Cipolletta  1 , Giovanni Volpato  1   2 , Alessio Gasperetti  2   3 , Yari Valeri  1   2 , Quintino Parisi  1 , Antonio Curcio  4 , Andrea Natale  5   6   7 , Antonio Dello Russo  1   2 , Michela Casella  1   8
Affiliations
Review

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Paolo Compagnucci et al. J Clin Med. .

Abstract

Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary "sports heart team" evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients' safety.

Keywords: arrhythmic mitral valve prolapse; electroanatomical mapping; electrophysiology study; guidelines; mitral regurgitation; mitral valve prolapse; physical exercise; risk stratification; sports cardiology; ventricular arrhythmias.

PubMed Disclaimer

Conflict of interest statement

Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and Abbott Medical and has received speaker honoraria/travel from Medtronic, Atricure, Biotronik, and Janssen; Dr. Dello Russo is a consultant for Abbott Medical; Dr. Casella has received speaker honoraria from Biosense Webster. All other authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Pathophysiology of AMVP and its complex interplay with sports activity.
Figure 2
Figure 2
Phenotypic features of AMVP at non-invasive tests.
Figure 3
Figure 3
Pickelhaube sign, a distinctive spike during systole of the lateral mitral annulus using tissue Doppler.
Figure 4
Figure 4
Electroanatomical substrate of a 54-year-old leisure-time sportsman with AMVP presenting with VT storm. There is clear-cut evidence of inferior–lateral perimetral scar with late potentials; radiofrequency energy delivery in the area rapidly led to VT termination.
Figure 5
Figure 5
Proposed flowchart for sports eligibility assessment in athletes with MVP.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Freed L.A., Levy D., Levine R.A., Larson M.G., Evans J.C., Fuller D.L., Lehman B., Benjamin E.J. Prevalence and clinical outcome of mitral-valve prolapse. N. Engl. J. Med. 1999;341:1–7. doi: 10.1056/NEJM199907013410101. - DOI - PubMed
    1. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: A population-based study. Lancet. 2006;368:1005–1011. doi: 10.1016/S0140-6736(06)69208-8. - DOI - PubMed
    1. Theal M., Sleik K., Anand S., Yi Q., Yusuf S., Lonn E. Prevalence of mitral valve prolapse in ethnic groups. Can. J. Cardiol. 2004;20:511–515. - PubMed
    1. Battaglia V., Santangelo G., Bursi F., Simeoli P., Guazzi M. Arrhythmogenic Mitral Valve Prolapse and Sudden Cardiac Death: An Update and Current Perspectives. Curr. Probl. Cardiol. 2023;48:101724. doi: 10.1016/j.cpcardiol.2023.101724. - DOI - PubMed
    1. Sabbag A., Essayagh B., Barrera J.D.R., Basso C., Berni A., Cosyns B., Deharo J.C., Deneke T., Di Biase L., Enriquez-Sarano M., et al. EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed by the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society. Europace. 2022;24:1981–2003. doi: 10.1093/europace/euac125. - DOI - PMC - PubMed

LinkOut - more resources