Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse
BackgroundMitral valve prolapse (MVP) is a common condition, typically benign, but in a small subset of patients, it may lead to life-threatening arrhythmias and sudden cardiac death (SCD). This arrhythmogenic MVP phenotype is often associated with bileaflet prolapse, mitral annular disjunction (MAD...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2025.1654085/full |
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| author | Ali Alzammam Faisal Alanazi Sultan Alenazy Abdulmahsen Alsalman Abdulrahman Albadi Maysan Almegbel Ahmed Aljizeeri Muneera Altaweel Abdulmohsen Almusaad |
| author_facet | Ali Alzammam Faisal Alanazi Sultan Alenazy Abdulmahsen Alsalman Abdulrahman Albadi Maysan Almegbel Ahmed Aljizeeri Muneera Altaweel Abdulmohsen Almusaad |
| author_sort | Ali Alzammam |
| collection | DOAJ |
| description | BackgroundMitral valve prolapse (MVP) is a common condition, typically benign, but in a small subset of patients, it may lead to life-threatening arrhythmias and sudden cardiac death (SCD). This arrhythmogenic MVP phenotype is often associated with bileaflet prolapse, mitral annular disjunction (MAD), and myocardial fibrosis identified via late gadolinium enhancement (LGE) on cardiac MRI.Case SummaryOur patient is a 49-year-old man presented with monomorphic ventricular tachycardia and near-syncope. Echocardiography showed bileaflet MVP, MAD and mild mitral regurgitation. Cardiac MRI revealed fibrosis in the papillary muscle. Electrophysiological study (EPS) confirmed inducible ventricular fibrillation (VF) triggered by papillary muscle PVCs. Catheter ablation was successfully performed, eliminating the arrhythmic focus. Despite successful ablation, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention, given the high-risk structural substrate. The patient remained arrhythmia-free over 2 years of follow-up.DiscussionThis case highlights critical diagnostic markers—bileaflet prolapse and LGE—associated with arrhythmogenic MVP. While ablation may suppress triggers, it does not completely eliminate the underlying substrate. Current expert consensus supports ICD implantation in patients with sustained VT/VF or sudden cardiac arrest, regardless of ablation success. Management should be individualized based on risk profile, imaging findings, and clinical presentation.ConclusionMalignant MVP warrants comprehensive evaluation with echocardiography, cardiac MRI, and EPS. Catheter ablation is effective in eliminating arrhythmic foci, but ICD therapy remains essential for secondary prevention. Future high-quality trials and clear guidelines for diagnosis, risk stratification, and management are essential to avoid both over- and under-treatment, ensuring optimal outcomes for the patients with MVP. |
| format | Article |
| id | doaj-art-fe648be52002445d878d0f47cfb772d6 |
| institution | Kabale University |
| issn | 1664-042X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj-art-fe648be52002445d878d0f47cfb772d62025-08-22T10:07:28ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2025-08-011610.3389/fphys.2025.16540851654085Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapseAli Alzammam0Faisal Alanazi1Sultan Alenazy2Abdulmahsen Alsalman3Abdulrahman Albadi4Maysan Almegbel5Ahmed Aljizeeri6Muneera Altaweel7Abdulmohsen Almusaad8Department of Adult Cardiology, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Adult Cardiology, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Adult Echocardiography, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Adult Echocardiography, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Adult Echocardiography, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Adult Cardiology, King Abdulaziz Cardiac Center, MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Internal Medicine, King Abdulaziz Hospital, MNGHA, King Abdullah International Medical Research Center (KAIMRC), Al-Ahsa, Saudi ArabiaDepartment of Electrophysiology, King Abdulaziz Cardiac Center, King Abdullah International Medical Research Center (KAIMRC), MNGHA, King Abdulaziz Medical City, Riyadh, Saudi ArabiaBackgroundMitral valve prolapse (MVP) is a common condition, typically benign, but in a small subset of patients, it may lead to life-threatening arrhythmias and sudden cardiac death (SCD). This arrhythmogenic MVP phenotype is often associated with bileaflet prolapse, mitral annular disjunction (MAD), and myocardial fibrosis identified via late gadolinium enhancement (LGE) on cardiac MRI.Case SummaryOur patient is a 49-year-old man presented with monomorphic ventricular tachycardia and near-syncope. Echocardiography showed bileaflet MVP, MAD and mild mitral regurgitation. Cardiac MRI revealed fibrosis in the papillary muscle. Electrophysiological study (EPS) confirmed inducible ventricular fibrillation (VF) triggered by papillary muscle PVCs. Catheter ablation was successfully performed, eliminating the arrhythmic focus. Despite successful ablation, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention, given the high-risk structural substrate. The patient remained arrhythmia-free over 2 years of follow-up.DiscussionThis case highlights critical diagnostic markers—bileaflet prolapse and LGE—associated with arrhythmogenic MVP. While ablation may suppress triggers, it does not completely eliminate the underlying substrate. Current expert consensus supports ICD implantation in patients with sustained VT/VF or sudden cardiac arrest, regardless of ablation success. Management should be individualized based on risk profile, imaging findings, and clinical presentation.ConclusionMalignant MVP warrants comprehensive evaluation with echocardiography, cardiac MRI, and EPS. Catheter ablation is effective in eliminating arrhythmic foci, but ICD therapy remains essential for secondary prevention. Future high-quality trials and clear guidelines for diagnosis, risk stratification, and management are essential to avoid both over- and under-treatment, ensuring optimal outcomes for the patients with MVP.https://www.frontiersin.org/articles/10.3389/fphys.2025.1654085/fullventricular tachcardiaventricular fibrilationventricular ablationmitral valve prolapspremature ventricle contraction/complexlate enhancement gadolinium |
| spellingShingle | Ali Alzammam Faisal Alanazi Sultan Alenazy Abdulmahsen Alsalman Abdulrahman Albadi Maysan Almegbel Ahmed Aljizeeri Muneera Altaweel Abdulmohsen Almusaad Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse Frontiers in Physiology ventricular tachcardia ventricular fibrilation ventricular ablation mitral valve prolaps premature ventricle contraction/complex late enhancement gadolinium |
| title | Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| title_full | Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| title_fullStr | Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| title_full_unstemmed | Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| title_short | Case Report: From multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| title_sort | case report from multimodality imaging to catheter ablation of ventricular arrhythmias in arrhythmogenic mitral valve prolapse |
| topic | ventricular tachcardia ventricular fibrilation ventricular ablation mitral valve prolaps premature ventricle contraction/complex late enhancement gadolinium |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2025.1654085/full |
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