Table 6.
Extended ECG monitoring
| Consensus statement on extended ECG monitoring | Symbol | Ref |
|---|---|---|
| A standard 24 h Holter monitoring is warranted in all patients with MVP. |
|
46,143 |
| Longer ECG recording (up to 7 days) may be beneficial in selected cases to allow more accurate quantification of PVC burden and/or correlation with symptoms. |
|
93 |
| MVP patients with complex ventricular ectopy (e.g. fast NSVTs) should be followed closely. |
|
Expert consensus |
| Due to the possibility of disease progression, periodic Holter may be advised as part of the routine follow-up of AMVPa patients. |
|
Expert consensus |
| Periodic Holter monitoring of PVC burden and periodic echocardiographic evaluation of LV function may be particularly helpful in patients with frequent PVC, even when asymptomatic and with normal LV function (to allow for a timely diagnosis of PVC induced cardiomyopathy). |
|
Expert Consensus144,145 |
| Longer ECG recording may be advised in patients with MVP and doubtful symptoms (e.g. recurrent pre-syncope or palpitations) in whom 24 h Holter monitoring was not revealing. |
|
Expert consensus |
| ILR may be advised in patients with MVP and unexplained syncope in whom non-invasive ECG monitoring was not revealing or inconclusive. |
|
102,146 |
| ILR may be advised in patients with AMVP, high risk featuresb and negative CMR. |
|
Expert consensus |
| ILR may be advised in patients with AMVP, at least 1 phenotypic risk featurec and positive LGE on CMRd. |
|
Expert consensus |
AMVP—The presence of MVP with or without MAD, frequent ventricular ectopy (≥5% of total beats), complex ectopy or sustained VAs in the absence of any other well-defined arrhythmic substrate (e.g. active ischaemia, ventricular scar due to another defined ethology, primary cardiomyopathy or channelopathy; ventricular scar due to other defined aetiology refers to ischaemic cardiomyopathy, dilated cardiomyopathy, post myocarditis, cardiac sarcoidosis etc.).
High risk features—sustained VT (haemodynamically tolerated), NSVT, unexplained syncope.
Phenotypic risk features—T-wave inversion in the inferior leads, repetitive documented polymorphic PVCs, mitral annular disjunction (MAD) phenotype, redundant MV leaflets, enlarged left atrium or ejection fraction ≤ 50%.
For this purpose, only LGE within the mitral apparatus (papillary muscles and peri-annular region) has a clear pathophysiological relevance. The significance of LGE in other regions remains unclear in this context.
AMVP, arrhythmic mitral valve prolapse; CMR, cardiac magnetic resonance; ECG, electrocardiogram; ILR, implantable loop recorder; LGE, late gadolinium enhancement; MAD, mitral annular disjunction; MVP, mitral valve prolapse; MV, mitral valve; NSVT, non-sustained ventricular tachycardia; PVC, premature ventricular contraction; VA, ventricular arrhythmia; VT, ventricular tachycardia.