Mitral valve prolapse and risk factors for ventricular arrhythmias and sudden cardiac death: a single-center study

General Medicine, 2025, 27(5), 17-22.

B. Grigorova, Iv. Daskalov, L. Demirevska

Clinic of Cardiology, Military Medical Academy – Sofia

Abstract. Introduction: Mitral valve prolapse (MVP) is a common cardiac disorder, considered benign. However, there may be some complications. Most serious are ventricular arrhythmias (VAs) and sudden cardiac death (SCD). According to the literature, there are several risk factors for their occurrence. Aim: To explore the prevalence and risk factors for the occurrence of VAs and SCD. То draw the attention of cardiologists and general practitioners to these factors when following-up patients with MVP. Materials and Methods: In our study we enrolled 109 (40.37% males) patients with MVP who were hospitalized in the Clinic of Cardiology in Military Medical Academy – Sofia for the period from April 2023 to April 2025. We examined them for the specific risk factors by: history, physical examination, laboratory tests, electrocardiogram (ECG), 24-hour ambulatory ECG, and transthoracic echocardiography (TTE). We performed a statistical analysis of the cases. We discussed our results, comparing them to the data from the literature. Results: Among all patients, no one had a SCD. 24-hour ambulatory ECG showed a rhythm pathology consisting of mono-/ polymorphic premature ventricular beats (PVBs) with varying degrees of complexity. According to these findings, we identified 20 (45% males) patients with frequent mono- and/or polymorphic PVBs and/or complex VAs. This group met the criteria for arrhythmogenic MVP – a phenotype that is at greater risk for SCD. We explored the risk factors in each of these 20 patients and found out that the most significant in our study are: pre-/syncope (65% of the patients), female 18 sex (55%) and bileaflet prolapse (10%). Conclusion: Although MVP is a common disorder, the estimated risk for SCD remains low. There are several known risk factors for VAs and SCD. In our study most frequent are syncope, female sex and bileaflet prolapse. Our results confirm the data from the literature regarding the low incidence of SCD in MVP and the risk factors with greater significance for the occurrence of VAs. Patients with MVP should be regularly followed-up for these predictors to prevent life-threatening arrhythmias.

Key words: mitral valve prolapse, ventricular arrhythmias, sudden cardiac death, risk factors

Address for correspondence: Boriana Nedialkova Grigorova, MD, тел.: +359 884716620, e-mail: bgrigorova@vma.bg