A CASE OF ARRHYTHMIC MITRAL VALVE PROLAPSE

Mitral valve prolapse (MVP) is a common valvular abnormality and the natural history of MVP is generally benign. However, MVP has been associated with an increased risk for arrhythmic sudden cardiac death (SCD). Moreover, ventricular and supraventricular arrhythmias are common in patients with MVP. Therefore, risk stratification for SCD is particularly challenging in patients diagnosed with MVP. There are several marker that may be associated with heightened risk of SCD including family history of SCD, T–wave inversion in the inferior leads on the 12–lead ECG, ventricular arrhythmias on ambulatory ECG, echocardiographic measures such as several mitral regurgitation, leaflet redundancy, mitral anular disjunction (MAD), left ventricular systolic dysfunction as well as myocardial fibrosis in the left ventricular inferolateral basal region and papillary muscles detected by magnetic resonance imaging. It is important to identify patients at high arrhythmic risk to implement appropriate primary prevention strategy of SCD. We report the asymptomatic patient with MVP and higher risk of SCD.A 48 years–old man was asymptomatic and with no relevant personal and family history. He finded frequent ventricular ectopic beats, with LBBB and DBBB morphology and superior axis at exercise stress test during screening for competitive sport eligibility. The previous transthoracic echocardiogram showed the mitral valve with a myxomatous appearance and prolapse of both leaflets, as well as MAD and preserved biventricular systolic function.The electrocardiogram (ECG) showed sinus rhythm with non–specific ventricular repolarization alterations. Coronary computed tomography angiography excluded coronary disease. The 24–hour Holter ECG revealed very frequent premature ventricular contractions (PVCs), 17% of all beats, polymorphic with LBBB or DBBB morphology and superior axis, in bigeminy and trigeminy, with frequent doublets and triplets. The patient was referred for cardiac magnetic resonance imaging (CMRI), which revealed basal inferior–lateral fibrosis by late gadolinium enhancement, mitral valve prolapse and mitral anular disjunction, with a distance of 15 mm.The patient is diagnosed MPV at high arrhythmic risk. Was initiated medical therapy with beta–blockers, frequent monitoring and abstention from intense–moderate physical activity.