Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1265-1275. doi: 10.1016/j.jacep.2023.02.010. Epub 2023 Apr 19.
In patients with bileaflet mitral valve prolapse (MVP), mitral annular disjunction (MAD) is associated with increased risk of sudden cardiac death via incompletely understood mechanisms.
This study assessed the substrate for ventricular arrhythmias in patients with bileaflet MVP and MAD as well as outcomes of catheter ablation with an emphasis on sustained, monomorphic ventricular tachycardia (VT).
A total of 18 consecutive patients (11 women, mean age 54 ± 15 years) with bileaflet MVP and MAD underwent catheter ablation for VT, and/or premature ventricular complexes (PVCs). Eight patients had a prior cardiac arrest.
PVCs were targeted for ablation in all 18 patients (symptomatic PVCs n = 15, PVC-induced ventricular fibrillation n = 3). Sustained monomorphic VT was targeted in 7 of 18 patients. Electroanatomic mapping showed low voltage in the area of the mitral annulus corresponding to VT target sites in 6 of 7 patients with sustained VT. Four of 7 patients had low voltage in the areas of MAD. Six of 7 patients with VT were rendered noninducible post-ablation. The PVC burden was reduced from 11.0% ± 10.4% to 4.0% ± 5.5% (P = 0.004). Over a mean follow-up of 33.9 ± 43.4 months, no VTs recurred. There were no major complications. No repeat ablations for VT occurred. Five of 18 patients required repeat ablation for PVCs.
In patients with bileaflet MVP and MAD undergoing catheter ablation, the mitral valve annulus often contains low-voltage areas harboring the substrate for monomorphic VT and PVCs. Ablation in these patients was safe and improved arrhythmia control.
在二尖瓣双叶脱垂（MVP）患者中，二尖瓣环分离（MAD）与通过尚未完全了解的机制导致心脏性猝死风险增加有关。
本研究评估了 MVP 和 MAD 患者室性心律失常的发生机制，以及导管消融的结果，重点关注持续性单形性室性心动过速（VT）。
连续 18 例二尖瓣双叶 MVP 和 MAD 患者因 VT 和/或室性早搏（PVC）行导管消融治疗，8 例患者曾发生心脏骤停。
18 例患者均针对 PVC 进行消融（症状性 PVC15 例，PVC 诱发心室颤动 3 例）。7 例患者中，持续性单形性 VT 是消融靶点。在 7 例持续性 VT 患者中，6 例患者的 VT 靶点区域的电激动图显示低电压。7 例患者中，4 例 MAD 区域存在低电压。6 例 VT 患者消融后均不能诱发 VT。PVC 负荷从 11.0%±10.4%降至 4.0%±5.5%（P=0.004）。平均 33.9±43.4 个月的随访期间，无 VT 复发。无严重并发症。无 VT 复发患者需要再次消融。18 例患者中有 5 例因 PVC 需要再次消融。
在二尖瓣双叶 MVP 和 MAD 患者中，行导管消融时，二尖瓣瓣环常存在低电压区，是单形性 VT 和 PVC 的发生基质。这些患者的消融安全且能改善心律失常的控制。
