Sudden Death in a Breastfeeding Woman with Arrhythmogenic Mitral Valve Prolapse

Introduction

Mitral valve prolapse (MVP) is the most common valvular heart disease, affecting 2-3% of the general population, and is defined by the systolic displacement of one or both mitral valve leaflets ≥2 mm above the plane of the mitral annulus in the sagittal view of the mitral valve via echocardiography. The outcomes of MVP without regurgitation are generally benign; however, a small, ill-defined subgroup of individuals is at high risk for malignant arrhythmias and sudden death (SD). Autopsy data show a 4% to 7% prevalence of MVP in young people with SD. Due to the low event rate and lack of cohorts with a robust number of patients, accessing the accurate incidence of SD and MVP in the general population and in patient subgroups remains a challenge. The diagnosis of arrhythmogenic MVP is made in the presence of MVP and ventricular arrhythmia, considering a ventricular arrhythmia density ≥5% on 24-hour electrocardiogram (ECG) Holter or the presence of complex arrhythmia – non-sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT) or ventricular fibrillation (VF), as well as in the absence of any other arrhythmogenic substrate.

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