Relation of sudden death in pure mitral regurgitation, with and without mitral valve prolapse, to repetitive ventricular arrhythmias and right and left ventricular ejection fractions
Complex ventricular arrhythmias are common in patients with mitral regurgitation (MR), with and without mitral valve prolapse (MVP], and short-term mortality is high in unoperated patients with MR who have depressed right ventricular (RV) or left ventricular (LV) ejection fractions (EF) at rest.1,2 Death in these patients may result either from severe hemodynamic failure or from a sudden arrhythmic event,3 as occurs in other forms of heart disease.4-6The hypothesis that arrhythmic death occurs in MR is supported by few previous observations beyond observed mortality in medically treated patients2,7 and arrhythmia-related postoperative mortality in patients undergoing mitral valve replacement.8 However, recognition of primary valvular disease among a small subset of survivors of cardiac arrest9,10 suggests that arrhythmias in MR are not necessarily benign. In addition, sudden death has been associated with MVP11 and occurs more often in MVP patients with hemodynamically important MR.12,13 Because MVP is emerging as the most common cause of severe MR,14 and because arrhythmia complexity in MR appears to be independent of etiology,1 the present study was undertaken to examine the relation of repetitive ventricular arrhythmias to the likelihood of death and to the mode of death in unoperated patients with MR with or without MVP. © 1987.
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