Mitral valve prolapse causing ventricular arrhythmias

[johnp]

Greetings all. I am new here. 48 yrs old, very active, otherwise very healthy.

I have a long history of mitral valve prolapse which appeared to have eventually led to serious problems with ventricular tachycardia. The growing frequency of the arrhythmias (including several episodes of sudden cardiac arrest) helped hasten my decision to have an MV repair done asap. The MV repair was done Dec 27. So far, so good.

I am interested in knowing if anyone else has experienced similar problems, and if MV repair or replacement made a difference (good or bad) is managing the ventricular arrhythmias.

Thanks

 

[Duff Man]

My uncle died suddenly due to arrhythmia because of mitral valve prolapse along with concentric left ventricular hypertrophy... at least that's what the autopsy report concluded.

 

[normofthenorth]

John, your question suggests a "back story". Are your present, post-op arrhythmias similar to the ones you had pre-op? Worse? To the extent that your MV prolapse and regurg were responsible for your arrhythmias, one would naturally expect them to improve. I assume that hopeful expectation was part of the "pitch" you got from your cardio and your surgeon, pre-op.

Unfortunately, OHS does sometime seem to introduce electrical and heart-rhythm problems of its own, and several kinds of arrhythmias (PVCs, A-flutter, A-fib) are quite common in the immediately post-op period, and "not uncommon enough" in the longer term. My rhythm seemed perfect pre-op, but I've had
higher than pre-op PVC frequency, a few sessions of A-flutter, A-fib, and one session of crazy tachycardia (150 HR) along with A-flutter & A-fib post-op, all within the first ~3 weeks. (So far so good in the following 4 weeks, though I'm on metoprolol and my resting HR is still much higher than pre-op.)

I won't know until around March 1 (48-hr Holter test) whether I'm free enough of arrhythmias to come off the metoprolol and the (3 months of) Warfarin.

What are you experiencing?

 

[Nupur]

johnp, if you don't my asking, why didn't your cardio recommend surgery at the onset of ventricular tachycardia, and it took several cardiac arrests to head to surgery? Just curious, since I have some pesky weird beats, and I am considering getting a 48 hour holter and wondering if I did have arrhythmia if that would affect the otherwise "wait until LV starts enlarging" strategy my cardio has. I hope that the worst is over for you. All the best

 

[johnp]

To answer some questions-

This is a very complicated history. I will try to address as best I can, and then list the full historical details.

My experience with Mitral Valve Prolpase was one of the worst nightmares possible. Since about the age of 24, I thought I was having serious heart issues, but was told time and again that MVP and these palpitations were harmless and there was no need to worry. I've had upwards of 10 cardiologists and 4 electrophysiologists look at my echoes my EKGs etc. Only one suggested a possible connection, but becuase my MVP was not severe, no action was taken. Then I went into Cardiac Arrest in March of 2009. Then again March 2010 and 3 weeks later in April of 2010. After an ablation where the focal site was determined to be the papillary muclle of the mitral valve, I asked the eletrophysiologist if we could associate the MVP with sudden cardiac arrest, he said he didn't think so. After several conversations I ended up being referred to the "Sudden Death Clinic" at Mayo in MN where I met with the Dr who is probably the authority on suddent cardiac death among young people and athletes. fairly depressing when you are being referred to the "sudden death clinic." Anyway, he agreed the MVP and sudden death was a somewhat controversial topic in the medical community, but he felt convinced that I was one of the "rare cases" where MVP can lead to a lethal cardiac arrest.

For me the next step was a no-brainer, get the MVP addressed.

And that brings me to where I am now - post MVP repair and thinking about my next move. And I am wondeing if anyone here with MVP has experienced serious ventricular arrhythmisas.

Thanks again-





Here medical history and timeline below.

1986 Aged 24 Sudden rush of fear and a sensation as if my heart had stopped
Lasted for about 5 seconds, felt like I was going to pass out
2nd event, similar feelings, about one month later
1987-2001 Felt palpitations on and off throughout late 1980s and 90s, but eventually started to ignore them.
September 22, 2001 Sensation of 2-3 very forceful and painful beats. Passed out during high level of exertion - was swimming in very rough ocean surf.
Felt palpitations for the next 6 months. Many days the palpitations quite frequent and bothersome.
March 2002 Visited local cardiologist. Got 24 halter monitor (noted occasional PVCs, numerous PACs, one 3 beat run of SVT)
(Local cardiologist reported it only showed I had "extra beats", "no reason for concern")
May 2002 Felt sudden tightness in chest, fluttering sensation, almost passed out while waiting for subway.
This was followed by 1 hour of intense palpitations, shortness of breath
Documented short run of ventricular tachycardia when admitted to local ER
Echo, Cardiac Cath, tilt table, and EP study all done after admitted to Hosp
Cardiac cath fine (no block), EP study induced VF but overall report was "polymorphic"/ "non specific"
Echo, MRI (MVP with MR mild-moderate) no structural abnornalities
ICD installed, 50 MG of toprol. Diagnosed as Idiopathic Ventricular Tachycardia
Minor palpitations on and off next two years, palpitations always most noticeable after eating. ICD Device recorded PVCs and isolated SVTs
December 2004 Paced out of VT by ICD, per interrogation
March/April 2007 8 second run of Ventricular Fibrillation, non sustained, per ICD interrogation Shock aborted. Very near syncope. Was a high level of exertion
2007 - 2008 Felt papitations on and off but again started to ignore them
March 22, 2009 Ventricular Fibrillation, syncope, ICD shock. Was a moderate level of exertion
May 2009 Cut out all caffeine. Immediately noticed far fewer palpitations. Thought that caffeine might have been culprit all along.
Also focused on better hydration with electrolytes during exercise.
March 8, 2010 Non sustained VT ( 8 beats) per device interrogation, during a 2 mile very slow jog HR approx 125.
March 14 2010 Ventricular Fibrillation, syncope, ICD shock, on first mile of what would have been a 10 mile run, moderate pace (target HR 135-140)
March 29 2010 Ventricular Fibrillation, syncope, ICD shock, very low level of exertion, HR probably around 90-100 max
April 2010 24 Hr Halter monitor showed polymorphic PVCs (3900 PVCS/day, a single run of 5 PVCs)
Treadmill stress test: many PVCs, 2 short runs VT (3 beats) once HR got to 120 BPM
Monitor compared with past EKGs, predominant location of PVC was observed (most PVCs but not all)
Genetic tests: CPVT. Long QT both Negative
May 2010 CAT Scan: Again no evidence of hypertrophic cardiomyopathy or other structural issues.
June 4, 2010 EP Study and ablation attempted
Able to induce VF, frequent ectopy - termed polymorphic
Predominant PVC located in papillary muscle by mitral valve, multiple lesions applied at high energy
Underlying cause still uncertain, but EP currently thinking along lines of CPVT
July 2010 Increased Toprol xl to 100mg
August 2 2010 5 second run of VF/Polymorphic VT, self terminating. Was not exercising
Sept 17 2010 5 second run of VF/Polymorphic VT, self terminating. Moderate level of exercise
Late September 2010 Had discussion with EP about options given apparent catecholamine trigger.
Asked if sympathetic denervation might be an option
Referred to Long QT/Sudden Death Clinic at Mayo Clinic in Minnesota.
Planned week visit, including full work up and sympathetic devernation procedure for end of week
Began a low dose of flecianide - immediately improved symptoms.
Follow-up 24 Holter showed dramatic decrease in PVCs and no more runs of PVCs after intro of flecianide
December 2010 Mayo Visit
Echo now showed MVP with very severe regurgitation
Severe left atrial enlargement, moderate left ventricular enlargement
No other structural issues noted on other tests
EP noted multifocal PVCs - but noted them coming from the papillary muscle region of the left ventricle
Mayo physicians felt there was a compelling case to link the MVP to the serious cardiac events.
Explained that MVP/Cardiac Arrest was rare, but observed in the MVP population
Denervation procedure postponed (for now)
Mitral valve repair performed - mininally invasive robotic assissted. No complications
Follow-up echo suggests repair successful, minimal MR
Future - Next 6 Mos Follow-up echoes and EKGs/24 hr
Reduce beta blocker and flecainide to see if PVCs remain dormant
Potential for future ablations also discussed if PVCs remain present

 

[AgilityDog]

Short answer. Yes.
March 2006 I got a bad case of bronchitis.
April 12, 2006 is probably the date when my minor mvp became a major tear/prolapse. Undiagnosed for nearly 5 months. "oh Laurie, you couldn't have a heart problem and run dog agility! Wanna bet? I fired that internist.
Diagnosis 8/25/2006: severe MVP and in-and-out a-fib.
9/5/2006 I had mitral valve replaced, and a maze procedure. Got a pacemaker. Had one post-op ICU incident of v-tach, thought to be caused by drug therapy. I fired that hospitalist, while I lay in ICU. I'm a real witch.
15 months later, v-tach, replaced the pacemaker with ICD, and started sotalol, on top of the coreg, coumadin, etc.
So far, so good, only one bout of v-tach since then, probably triggered by MSG in Japanese food, but the ICD and an extra dose of sotalol took care of that.
August, 2010, I had my aortic valve replaced, due to damage from the initial severe MVP, and the tricuspid repaired because of the stress of all the wires running through it.
Yes, MVP can cause v-tach.

 

[debster913]

Short answer. Yes.
April 12, 2006 is probably the date when my minor mvp became a major tear/prolapse. Yes, MVP can cause v-tach.

Laurie,
My valve failed a day before yours on April 11, 2006! :thumbd:

I agree--however, now I have added A-Fib to my heart rhythm issues because of the post-op scar tissue. I had my V-Tach ablated in December 2008.

 

[Bear72]

Were you on beta blockers pre-op? I know that post-op, you're probably on a fairly high dosage which can often keep v-tach in check.

 

[johnp]

Yes I was on a high dose of beta blockers pre-op. The beta blockers did NOT control my V-tach. But as I noted above, the Flecainide appeared very effective.
I am now on a lower dose of beta blockers and the longer term plan is that I try to go off of them completely.

 

[Michelle D]

I didn't not have MVP but my mitral valve was in rough shape, don't know why but leaking +4, I've had PVCs since before I had mitral valve problems and I'm six months after OHS to repair my mitral valve and unfortunately I still have PVCs, not v-tach though so I'm thankful for that. But OHS added a new palp to my repertoire, I now have atrial flutter.

My cardiologist said her mitral valve patients have the most problems with palpations.

 

[Johnz]

John, I also had MVP for nearly 2 decades. In 2009 I was rushed to the ER with a heart rate over 200bpm and underwent electrocardioversion to restore normal rhythym. Neither the cardiologist nor the electrophysiologist thought there was any connection to the MVP. They thought it was supra ventricular tachycardia and put me on some beta blockers. I went for an ablation and they thought they might have resolved it, but weren't sure. A year later I had the same episode and they concluded it was Ventricular Tachycardia and I was at serious risk. I opted for another attempt at ablation at a different hospital and it was successful. Two weeks later I contracted endocarditis - went the full 6 weeks of antiobiotics - and scheduled surgery for the mitral valve repair (which was last July). To this day, the doctors have drawn no connection between the electrical problems and the MVP. The electrical emergencies were brought on by physical exertion. Since the ablation and MVR surgery, I have been able to work out in the gym intensely and have had no episodes,. So I can only conclude that the problem is resolved. The question is: was it only the ablation that did it, or did the MVR help? I don't think I'll ever know.

 

[Marcia58]

JohnP -

Before my repair, I used to throw PVCs all the time. Never seemed anything but annoying, but still....

Since my surgery, I haven't had any, as far as I can recall, for almost 2 years now.

Marcia