The Knot That Binds Mitral Valve Prolapse and Sudden Cardiac Death
Solving the puzzle that ties mitral valve prolapse (MVP) to sudden cardiac death (SCD) necessarily means overcoming two central challenges: establishing a mechanistic association between a very common disorder (MVP) and a rare outcome (SCD) and discerning the cause and effect of an increasing array of associated structural, electrocardiographic, and now pathological findings.
In this issue of Circulation, Basso et al1 demonstrate an important and possibly critical piece of this association -pathologic and MRI evidence of a possible underlying arrhythmogenic substrate. Studying two distinct and complementary populations (young patients who died suddenly with MVP as the sole structural cardiac abnormality and a group of patients with mitral valve prolapse and complex ventricular arrhythmia) and suitable control groups, they report pathological and MRI findings that strongly suggest arrhythmogenic substrate in the region of the mitral valve apparatus that may explain a hitherto missing link between MVP and SCD.1
- Received July 6, 2015.
- Accepted July 8, 2015.