Imaging Features of Arrhythmogenic Mitral Valve Prolapse: Clinical Cases and Literature Review

Abstract

Mitral valve prolapse (MVP) is one of the leading causes of primary mitral regurgitation. In addition to complications arising from valvular insufficiency, MVP can also progress to arrhythmias, ranging from premature ventricular contractions to potentially lifethreatening episodes such as non-sustained ventricular tachycardia or malignant ventricular arrhythmias. Recently, the term "arrhythmic mitral valve prolapse syndrome" has been reported as a potential cause of sudden cardiac death. Consequently, there has been increasing research interest in this condition, accompanied by updated guidelines from various cardiovascular societies. Arrhythmic MVP is classified as a distinct subgroup characterized by frequent or complex ventricular arrhythmias without underlying structural arrhythmogenic substrate, with or without mitral annular disjunction (MAD). Studies have demonstrated that MAD is associated with an increased risk of arrhythmias and sudden cardiac death in patients with MVP. Advances in cardiac imaging, particularly cardiac magnetic resonance (CMR), now enable comprehensive evaluation of this condition. Moreover, CMR plays a pivotal role in arrhythmic risk stratification and in identifying high-risk myocardial fibrosis patterns. This article presents a series of clinical cases along with a literature review to provide additional information and updated insights into this condition