https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland
Background: Sudden cardiac death has been reported to occur in 0.3% of patients with mitral valve prolapse (MVP) per year. On the other hand MVP is relatively common valve variant with an estimated prevalence of 2-3% in the general population. Therefore risk stratification in this collective remains challenging. The Tpeak to Tend interval (TpTe) as marker of dispersion of repolarization has been linked to increased arrhythmic risk in different clinical settings like Brugada syndrome or hypertrophic cardiomyopathie. The aim of this study was to observe the correlation of TpTe and VT inducibility during programmed ventricular stimulation in patients with suspected “arrhythmic MVP syndrome”.
Methods and results: 63 patients with MVP (62% female, mean age 48 ± 14 years) underwent programmed ventricular stimulation between 2016 and 2024. Programmed right ventricular apex an outflow tract stimulation (500, 430, 370 and 330 ms) was conducted with up to two extrastimuli (minimum 150 ms). Cardiac MRI was performed in 60 patients (95.2 %). Mean TpTe was 89.9 ± 12.1 ms and TpTe/QTc 0.21 ± 0.03. Sustained ventricular tachycardia (VT) was induced in 18 patients (28.6 %) and was significantly associated with prolonged TpTe (101.1 ± 10.2 ms vs. 85.4 ± 9.8 ms, p = 0.03) and prolonged TpTe/QTc (0.24 ± 0.03 vs. 0.2 ± 0.02, p = 0.04).
Conclusion: Prolonged TpTe was associated with VT inducibility in patients with suspected “arrhythmic MVP syndrome”. Further studies are needed to examine if prolonged TpTe also correlates with clinical significant arrhythmic events.