The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse

Niyada Naksuk, Faisal F. Syed, Chayakrit Krittanawong, Mark J. Anderson, Elisa Ebrille, Christopher V. DeSimone, Vaibhav R. Vaidya, Shiva P. Ponamgi, Rakesh M. Suri, Michael John Ackerman, Vuyisile T Nkomo, Samuel J Asirvatham, Peter Noseworthy

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients. Methods We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B). Results In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04). Conclusions MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

Original languageEnglish (US)
Pages (from-to)187-191
Number of pages5
JournalIndian Pacing and Electrophysiology Journal
Volume16
Issue number6
DOIs
StatePublished - Nov 1 2016

Fingerprint

Mitral Valve Prolapse
Mitral Valve
Cardiac Arrhythmias
Odds Ratio
Confidence Intervals
Ambulatory Electrocardiography
Mitral Valve Insufficiency
Left Ventricular Function

Keywords

  • Bileaflet mitral valve prolapse
  • Mitral valve surgery
  • Papillary ventricular arrhythmias
  • Sudden cardiac death
  • Ventricular arrhythmias
  • Ventricular ectopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse. / Naksuk, Niyada; Syed, Faisal F.; Krittanawong, Chayakrit; Anderson, Mark J.; Ebrille, Elisa; DeSimone, Christopher V.; Vaidya, Vaibhav R.; Ponamgi, Shiva P.; Suri, Rakesh M.; Ackerman, Michael John; Nkomo, Vuyisile T; Asirvatham, Samuel J; Noseworthy, Peter.

In: Indian Pacing and Electrophysiology Journal, Vol. 16, No. 6, 01.11.2016, p. 187-191.

Research output: Contribution to journalArticle

Naksuk, Niyada ; Syed, Faisal F. ; Krittanawong, Chayakrit ; Anderson, Mark J. ; Ebrille, Elisa ; DeSimone, Christopher V. ; Vaidya, Vaibhav R. ; Ponamgi, Shiva P. ; Suri, Rakesh M. ; Ackerman, Michael John ; Nkomo, Vuyisile T ; Asirvatham, Samuel J ; Noseworthy, Peter. / The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse. In: Indian Pacing and Electrophysiology Journal. 2016 ; Vol. 16, No. 6. pp. 187-191.
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abstract = "Background Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients. Methods We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10{\%} reduction in VE burden compared to baseline) were compared with the rest of study patients (group B). Results In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1{\%}), VE burden decreased by at least 10{\%} after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95{\%} confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95{\%} confidence interval 1.04–4.3 per 10-year; P = 0.04). Conclusions MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.",
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AU - Naksuk, Niyada

AU - Syed, Faisal F.

AU - Krittanawong, Chayakrit

AU - Anderson, Mark J.

AU - Ebrille, Elisa

AU - DeSimone, Christopher V.

AU - Vaidya, Vaibhav R.

AU - Ponamgi, Shiva P.

AU - Suri, Rakesh M.

AU - Ackerman, Michael John

AU - Nkomo, Vuyisile T

AU - Asirvatham, Samuel J

AU - Noseworthy, Peter

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N2 - Background Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients. Methods We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B). Results In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04). Conclusions MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

AB - Background Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients. Methods We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B). Results In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04). Conclusions MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

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KW - Mitral valve surgery

KW - Papillary ventricular arrhythmias

KW - Sudden cardiac death

KW - Ventricular arrhythmias

KW - Ventricular ectopy

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