Prevalence and clinical phenotype of concomitant long QT syndrome and arrhythmogenic bileaflet mitral valve prolapse

John R. Giudicessi, Ram K. Rohatgi, Johan M. Bos, Michael J. Ackerman

    Research output: Contribution to journalArticlepeer-review

    9 Scopus citations

    Abstract

    Background: Mitral valve prolapse (MVP), including the recently described arrhythmogenic bileaflet MVP syndrome (ABiMVPS), is associated with repolarization abnormalities and may represent an underestimated cause of sudden cardiac death. The impact of concomitant MVP or ABiMVPS on long QT syndrome (LQTS) clinical severity is unknown. Methods and results: Retrospective review of 754 LQTS patients [445 females (58%) and mean QTc 471 ± 41 ms] with available echocardiographic data was performed to identify LQTS patients with not only MVP, but also a pro-arrhythmic ABiMVPS phenotype defined as bileaflet MVP, inferolateral T-wave inversions, and frequent complex ventricular ectopy/arrhythmia. As expected, 18/754 (2%) LQTS patients had concomitant MVP. Of these, 5/18 (28%) LQTS patients with MVP satisfied ABiMVPS diagnostic criteria. No difference in symptomatology, degree of QT prolongation, or clinical management was observed between LQTS patients with and without MVP. In contrast, LQTS plus ABiMVPS resulted in a severe cardiac phenotype as illustrated by symptomatic status (LQTS-ABiMVPS; 5/5; 100%; vs LQTS: 279/736; 39%; p =.008), degree of baseline QTc prolongation (LQTS-ABiMVPS: 536 ± 58 ms; vs LQTS: 470 ± 40 ms; p =.009), and number of patients experiencing ≥1 on-therapy break-through cardiac event (LQTS-ABiMVPS: 4/5; 80%; vs LQTS: 48/736; 7%; p <.001]. Lastly, individuals with LQTS plus ABiMVPS were more likely to experience appropriate ICD therapies post-cardiac denervation (LQTS-ABiMVPS: 2/3; 67% vs LQTS: 4/49; 8%; p =.03]. Conclusions and relevance: The co-existence of LQTS and ABiMVPS may lead to a rare, but malignant, clinical entity characterized by potentially life-threatening arrhythmias despite maximal LQTS therapy.

    Original languageEnglish
    Pages (from-to)175-178
    Number of pages4
    JournalInternational Journal of Cardiology
    Volume274
    DOIs
    StatePublished - Jan 1 2019

    Keywords

    • Arrhythmia
    • Long QT syndrome
    • Mitral valve prolapse
    • Out-of-hospital cardiac arrest
    • Sudden cardiac death

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