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Objective: Arrhythmias have been reported to occur frequently in symptomatic patients with mitral valve prolapse (MVP). The mechanisms causing atrial arrhythmias in patients with MVP have not been fully investigated. The purpose of this study was to determine the clinical, echocardiographic and heart rate variability parameters, and plasma concentrations of electrolytes and inflammatory markers in predicting atrial arrhythmias in patients with MVP., Methods: A total of 58 consecutive patients with MVP were included in this study. We performed electrocardiography, echocardiography, Holter analysis, routine biochemical tests including plasma concentrations of electrolytes and inflammatory markers, and evaluated the clinical characteristics. Atrial arrhythmia was defined as occurrence of any of the following: atrial premature contractions, atrial couplets, supraventricular tachycardia, atrial flutter or fibrillation documented by Holter analysis, continuous monitoring or by electrocardiography., Results: Twenty-eight patients (48%) had atrial arrhythmias, and 30 (52%) patients had no atrial arrhythmias. Univariable predictors of atrial arrhythmias included isovolumetric relaxation time, lateral systolic (S'), lateral late diastolic (A'), septal A' Doppler velocities, anterior mitral leaflet thickness, anterior mitral leaflet thickness of > or =5 mm, posterior mitral leaflet thickness and the occurrence of moderate to severe mitral regurgitation. Multivariable logistic regression analysis showed that occurrence of moderate to severe mitral regurgitation was the only independent predictor of atrial arrhythmias (relative risk: 2.4, 95% confidence interval 1.32-4.86, P = 0.005)., Conclusions: The present study showed that the only independent predictor of atrial arrhythmias in patients with MVP is the occurrence of moderate to severe mitral regurgitation.