PDF(Pubmed)
Abstract：
The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular arrhythmias (VAs) associated with MVP. Despite having high procedural success, outcome data after CA is limited, especially in a long-term setting. Therefore, this systematic review and meta-analysis were performed. Literature searching was conducted in Pubmed, EuropePMC, Proquest, and Ebsco from inception to December 2020 using keywords: ventricular arrhythmia, premature ventricular complex, ventricular tachycardia, ventricular fibrillation, mitral valve prolapse, and catheter ablation. A total of 407 potential articles were retrieved for further review. The final review resulted in six articles for systematic review and meta-analysis. The study was registered in PROSPERO (CRD42020219144). The most common origin of VAs was papillary muscle. The acute success rate of CA in the MVP group varies between 66% and 94%. Follow-up studies reported a higher percentage of VAs recurrence after CA in the MVP group (22.22%) compared with the non-MVP group (11.38%). However, the difference is not significant (P-value = 0.16). Other studies reported a 12.5%-36% rate and 40% of repeat ablation in the medium term and the long term, respectively. Episodes of sudden cardiac death during exertion could still occur following CA in patients with MVP. Distinct origin of VAs was observed during repeated ablation procedures, which may explain arrhythmic substrate progression. Diffuse left ventricular fibrosis around papillary muscle rather than local fibrosis was observed among older patients. Furthermore, the presence of mitral annular disjunction (MAD) and Filamin C mutation might increase the risk of recurrent VAs. CAn has been done as the treatment of VAs associated with MVP. The acute success rate of CA varies between studies and the number of patients requiring repeat CA varied from 12.5% to 40%. Sudden cardiac death could still occur after CA. Older age during CA, genetic predisposition, deep arrhythmic foci, multifocal VAs origin, diffuse fibrosis, and the presence of MAD may contribute to the recurrence of VAs. Further studies, stratification, and evaluation are needed to prevent fatal outcomes in VA associated with MVP, even after CA.
摘要：
二尖瓣脱垂（MVP）的存在从无症状到危及生命的心律失常各不相同。导管消融（CA）广泛用于治疗与MVP相关的室性心律失常（VA）。尽管程序上取得了很高的成功，CA后的结果数据有限，尤其是在长期环境中。因此,本研究进行了系统评价和荟萃分析.文献检索是在Pubmed中进行的，EuropePMC,Proquest,和Ebsco从成立到2020年12月使用关键词：室性心律失常，室性早搏,室性心动过速,心室纤颤,二尖瓣脱垂,和导管消融。共检索到407篇潜在文章供进一步审查。最终审查产生了六篇文章进行系统审查和荟萃分析。该研究在PROSPERO（CRD42020219144）中注册。VAs最常见的起源是乳头状肌。MVP组CA的急性成功率在66％至94％之间变化。随访研究报告，与非MVP组（11.38％）相比，MVP组CA后VAs复发的百分比更高（22.22％）。然而,差异不显著(P值=0.16)。其他研究报告说，在中期和长期内，消融率为12.5％-36％，重复消融率为40％。分别。在患有MVP的患者中，在CA后仍可能发生运动期间心脏性猝死的发作。重复消融术期间观察到不同来源的VAs,这可以解释心律失常底物进展。在老年患者中观察到，在乳头状肌周围弥漫性左心室纤维化，而不是局部纤维化。此外，二尖瓣环分离(MAD)和FilaminC突变的存在可能会增加VAs复发的风险.CAn已被用作与MVP相关的VAs的治疗。CA的急性成功率因研究而异，需要重复CA的患者数量从12.5％到40％不等。CA后仍可能发生心脏猝死。CA期间年龄较大，遗传易感性,深心律失常病灶,多焦点VAs原点，弥漫性纤维化,MAD的存在可能导致VAs的复发。进一步研究,分层，并且需要评估以防止与MVP相关的VA的致命结局，甚至在CA之后。
