Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation

Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls.

Clinical Perspective

What Is New?

  • Idiopathic ventricular fibrillation has previously been associated with mitral valve prolapse.
  • Recent research has suggested an association between ventricular arrhythmias and mitral annulus disjunction, independently of mitral valve prolapse.
  • We found that mitral valve prolapse and mitral annulus disjunction are both significantly more prevalent in patients with idiopathic ventricular fibrillation than in controls.

What Are the Clinical Implications?

  • Mitral annulus disjunction and mitral valve prolapse are frequently overlooked and deserve extra attention in the extensive screening of patients with idiopathic ventricular fibrillation.

All included subjects underwent CMR examination on a clinical 1.5T or 3T magnetic resonance scanner using electrocardiographic gating and a phased array cardiac receiver coil according to standardized cardiac protocols. Breath‐hold balanced steady‐state free‐precession cine images covering both the ventricles and atria were acquired (4‐chamber long‐axis view, 2‐ and 3‐chamber long‐axis left ventricle [LV] views and multislice full coverage of the LV in short‐axis orientation). The voxel size of the cine sequences used was dependent on the local clinical scan protocol and was typically around 1.5×1.5×5 to 8 mm3. In addition, late gadolinium enhancement (LGE) imaging was performed at least 10 minutes after intravenous administration of a gadolinium‐based contrast agent in identical views. LGE imaging was not performed in control subjects.

Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.​

Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation | Journal of the American Heart Association (ahajournals.org)
Multicenter Study
J Am Heart Assoc. 2022 Aug 16;11(16):e025364.
Sanne A Groeneveld, Feddo P Kirkels, Maarten J Cramer, Reinder Evertz, Kristina H Haugaa, Pieter G Postema, Niek H J Prakken, Arco J Teske, Arthur A M Wilde, Birgitta K Velthuis, Robin Nijveldt, Rutger J Hassink
PMID: 35929463
PMCID: PMC9496286
DOI: 10.1161/JAHA.121.025364  

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