ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.
Europace. 2023 Feb 16;25(2):506-516. doi: 10.1093/europace/euac182.
Arrhythmic mitral valve syndrome is linked to life-threatening ventricular arrhythmias. The incidence, morphology and methods for risk stratification are not well known. This prospective study aimed to describe the incidence and the morphology of ventricular arrhythmia and propose risk stratification in patients with arrhythmic mitral valve syndrome.
Arrhythmic mitral valve syndrome patients were monitored for ventricular tachyarrhythmias by implantable loop recorders (ILR) and secondary preventive implantable cardioverter-defibrillators (ICD). Severe ventricular arrhythmias included ventricular fibrillation, appropriate or aborted ICD therapy, sustained ventricular tachycardia and non-sustained ventricular tachycardia with symptoms of hemodynamic instability.
During 3.1 years of follow-up, severe ventricular arrhythmia was recorded in seven (12%) of 60 patients implanted with ILR [first event incidence rate 4% per person-year, 95% confidence interval (CI) 2-9] and in four (20%) of 20 patients with ICD (re-event incidence rate 8% per person-year, 95% CI 3-21). In the ILR group, severe ventricular arrhythmia was associated with frequent premature ventricular complexes, more non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance (all P < 0.02).
The yearly incidence of ventricular arrhythmia was high in arrhythmic mitral valve syndrome patients without previous severe arrhythmias using continuous heart rhythm monitoring. The incidence was even higher in patients with secondary preventive ICD. Frequent premature ventricular complexes, non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance were predictors of first severe arrhythmic event.
心律失常性二尖瓣综合征与危及生命的室性心律失常有关。其发生率、形态和风险分层方法尚不清楚。本前瞻性研究旨在描述心律失常性二尖瓣综合征患者室性心律失常的发生率和形态，并提出风险分层方法。
通过植入式环路记录器（ILR）和二级预防植入式心脏复律除颤器（ICD）监测心律失常性二尖瓣综合征患者的室性心动过速。严重的室性心律失常包括心室颤动、适当或终止 ICD 治疗、持续性室性心动过速和非持续性室性心动过速伴有血流动力学不稳定的症状。
在 3.1 年的随访中，7 名（12%）植入 ILR 的 60 名患者[首次事件发生率为 4%/人年，95%置信区间（CI）为 2-9]和 20 名植入 ICD 的患者（4 名，20%）[再发事件发生率为 8%/人年，95%CI 为 3-21]记录到严重的室性心律失常。在 ILR 组中，严重的室性心律失常与频发室性期前收缩、更多的非持续性室性心动过速、更大的左心室直径和更大的后外侧二尖瓣环分离距离相关（均 P<0.02）。
在使用连续心脏节律监测的无先前严重心律失常的心律失常性二尖瓣综合征患者中，室性心律失常的年发生率较高。在二级预防 ICD 的患者中，发生率更高。频发室性期前收缩、非持续性室性心动过速、更大的左心室直径和更大的后外侧二尖瓣环分离距离是首次严重心律失常事件的预测因素。
