Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
Can J Cardiol. 2023 Oct;39(10):1397-1409. doi: 10.1016/j.cjca.2023.05.010. Epub 2023 May 20.
Arrhythmic mitral valve prolapse (MVP) has gained great interest recently because of the increasing recognition of its potential role in unexplained cardiac arrest. Although evidence has accumulated to show the association of arrhythmic MVP (AMVP) with sudden cardiac death (SCD), risk stratification and management remain unclear. Physicians are faced with the challenges of screening for AMVP among MVP patients and the dilemma of when and how to intervene to prevent SCD in these patients. In addition, there is little guidance to help approach MVP patients who present with an otherwise unexplained cardiac arrest to know whether MVP was the primary cause of cardiac arrest or just an innocent bystander. Herein we review the epidemiology and definition of AMVP, the risk and mechanisms of SCD, and summarize the clinical evidence behind risk markers of SCD and therapeutic interventions that could potentially prevent it. We also propose an algorithm that provides guidance as to how to screen for AMVP and what therapeutic interventions to use. Last, we propose a diagnostic algorithm for approaching patients with otherwise unexplained cardiac arrest who are shown to have MVP.
心律失常性二尖瓣脱垂 (Arrhythmic Mitral Valve Prolapse, AMVP) 因其在不明原因心搏骤停中的潜在作用而备受关注。尽管已有大量证据表明 AMVP 与心源性猝死 (Sudden Cardiac Death, SCD) 相关，但风险分层和管理仍不明确。医生面临着在 MVP 患者中筛查 AMVP 的挑战，以及在这些患者中何时以及如何进行干预以预防 SCD 的困境。此外，几乎没有指导方法来帮助处理表现为不明原因心搏骤停的 MVP 患者，以了解 MVP 是否是心搏骤停的主要原因，还是仅仅是一个无辜的旁观者。在此，我们回顾了 AMVP 的流行病学和定义、SCD 的风险和机制，并总结了 SCD 风险标志物和潜在预防措施的临床证据。我们还提出了一个算法，为如何筛查 AMVP 和使用何种治疗干预提供指导。最后，我们提出了一个诊断算法，用于处理表现为不明原因心搏骤停且被证实存在 MVP 的患者。
