Mitral Annular Disjunction in Idiopathic Ventricular Fibrillation Patients: Just a Bystander or a Potential Cause?

L M Verheul*, M Guglielmo, S A Groeneveld, F P Kirkels, C Scrocco, M J Cramer, M Bootsma, G F L Kapel, M Alings, R Evertz, B A Mulder, N H J Prakken, J C Balt, P G A Volders, A Hirsch, S C Yap, P G Postema, R Nijveldt, B K Velthuis, E R BehrA A M Wilde, R J Hassink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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AIMS: Previously, we demonstrated that inferolateral mitral annular disjunction (MAD) is more prevalent in patients with idiopathic ventricular fibrillation (IVF) than in healthy controls. In the present study, we advanced the insights into the prevalence and ventricular arrhythmogenicity by inferolateral MAD in an even larger IVF cohort.

METHODS AND RESULTS: This retrospective multicentre study included 185 IVF patients (median age 39 [27, 52] years, 40% female). Cardiac magnetic resonance images were analysed for mitral valve and annular abnormalities and late gadolinium enhancement. Clinical characteristics were compared between patients with and without MAD. MAD in any of the 4 locations was present in 112 (61%) IVF patients and inferolateral MAD was identified in 24 (13%) IVF patients. Mitral valve prolapse (MVP) was found in 13 (7%) IVF patients. MVP was more prevalent in patients with inferolateral MAD compared with patients without inferolateral MAD(42% vs. 2%, p < 0.001). Proarrhythmic characteristics in terms of a high burden of premature ventricular complexes (PVC) and non-sustained ventricular tachycardia (VT) were more prevalent in patients with inferolateral MAD compared to patients without inferolateral MAD (67% vs. 23%, p < 0.001 and 63% vs 41%, p = 0.046, respectively). Appropriate implantable cardioverter defibrillator therapy during follow-up was comparable for IVF patients with or without inferolateral MAD (13% vs. 18%, p = 0.579).

CONCLUSION: A high prevalence of inferolateral MAD and MVP is a consistent finding in this large IVF cohort. The presence of inferolateral MAD is associated with a higher PVC burden and non-sustained VTs. Further research is needed to explain this potential interplay.

Original languageEnglish
Pages (from-to)764-770
Number of pages7
JournalEuropean heart journal. Cardiovascular Imaging
Issue number6
Early online date27-Feb-2024
Publication statusPublished - 1-Jun-2024


  • cardiac magnetic resonance
  • idiopathic ventricular fibrillation
  • mitral annular disjunction
  • mitral valve prolapse
  • ventricular arrhythmias


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