Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-05T17:17:00.172Z Has data issue: false hasContentIssue false
  • English
  • Français

A prospective study to determine the significance of ventricular late potentials in children with mitral valvar prolapse

Published online by Cambridge University Press:  30 July 2009

Waldemar Bobkowski ,
Aldona Siwińska ,
Jacek Zachwieja ,
Bartłomiej Mroziński ,
Alina Rzeźnik-Bieniaszewska  and
Janusz Maciejewski
Waldemar Bobkowski*
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
Aldona Siwińska
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
Jacek Zachwieja
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
Bartłomiej Mroziński
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
Alina Rzeźnik-Bieniaszewska
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
Janusz Maciejewski
Affiliation:
Department of Pediatric Cardiology, Karol MarcinkowskiUniversity of Medical Sciences, Poznań, Poland
*
Department of Pediatric Cardiology, University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland. Tel: +4861 8491448; Fax: +4861 8483362; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

We aimed prospectively to determine the incidence of ventricular arrhythmias and ventricular late potentials in children with mitral valvar prolapse, and to assess whether signal-averaged electrocardiography could identify which such children were at high risk of developing ventricular tachycardia. In all, we examined 151 children with mitral valvar prolapse, at an age of 12.2 ± 3.1 years, and 164 healthy subjects aged 12.3 ± 3.7 years. All children underwent 24-hour ambulatory Holter monitoring and echocardiography. The children with mitral valvar prolapse were followed prospectively for a mean of 64 months. There was a significantly higher prevalence of ventricular arrhythmias in those with prolapse than in the controls (p < 0.0001). Runs of ventricular tachycardia were observed in 3 children with mitral valvar prolapse compared with one from the control group. Late potentials were more frequently observed in the children with mitral valvar prolapse than in those who were healthy (p < 0.0001), and also in those with prolapse suffering ventricular arrhythmias compared with those without ventricular arrhythmias (p < 0.02). During follow-up, 24 children with prolapsing mitral valves developed non-sustained ventricular tachycardia, giving a frequency of 3.1/100 subject-years. The sensitivity of late potentials was low, at 52%, for the identification of children with mitral valvar prolapse who developed ventricular tachycardia, although the specificity was high at 90%. This gave a positive predictive value of 50%, and a negative predictive value of 91%. We conclude that prolapse of the mitral valve predisposes to the development of ventricular arrhythmias and late potentials in children. An abnormal signal-averaged electrocardiogram is a specific, but not very sensitive, predictor for the development of ventricular tachycardia in such children.

Keywords

Paediatricsventricular arrhythmiassignal-averaged electrocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 12 , Issue 4 , July 2002 , pp. 333 - 338
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Babuty, D, Cosnay, P, Breuillac, JC et al. , Ventricular arrhythmia factors in mitral valve prolapse. Pacing Clin Electrophysiol 1994; 17: 1090–1099.CrossRefGoogle ScholarPubMed
2.Kavey, R-EW, Sondheimer, HM, Blackman, MS.Detection of dysrhythmia in patients with mitral valve prolapse. Circulation 1980; 62: 582–587.CrossRefGoogle ScholarPubMed
3.Kligfield, P, Levy, D, Devereux, RB, Savage, DD.Arrhythmias and sudden death in mitral valve prolapse. Am Heart J 1987; 113: 1298–1307.CrossRefGoogle ScholarPubMed
4.Leclercq, JF, Malergue, MC, Coumel, P.Late potentials and mitral valve prolapse. Arch Mai Coeur Vaiss 1993; 86: 285–289.Google ScholarPubMed
5.Zuppiroli, A, Mori, F, Favilli, S et al. , Arrhythmias in mitral valve prolapse: relation to anterior mitral leaflet thickening, clinical variables, and colour Doppler echocardiographic parameters. Am Heart J 1994; 128: 919–927.CrossRefGoogle ScholarPubMed
6.Breithardt, G, Borggrefe, M.Pathophysiological mechanisms and clinical significance of ventricular late potentials. Eur Heart J 1986; 7: 364–385.CrossRefGoogle ScholarPubMed
7.Breithardt, G, Cain, ME, El-Sherif, N et al. , Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography. A Statement by a Task Force Committee between the European Society of Cardiology, the American Heart Association and the American College of Cardiology. Eur Heart J 1991; 12:473–480.CrossRefGoogle ScholarPubMed
8.Denereaz, D, Zmmermann, M, Adamec, R.Significance of ventricular late potentials in non-ischemic dilated cardiomyopathy. Eur Heart J 1992; 13: 895–901.CrossRefGoogle Scholar
9.Nalos, PC, Gang, ES, Mandel, WJ, Ladenheim, MC, Lass, Y, Peter, T.The signal-averaged electrocardiogram as a screening test for inducibility of sustained ventricular tachycardia in high risk patients: a prospective study. J Am Coll Cardiol 1987; 9: 539–548.CrossRefGoogle ScholarPubMed
10.Zimmermann, M, Sentici, A, Adamec, R, Metzger, J, Mermillod, B, Rutishaauser, W.Long-term prognostic significance of ventricular late potentials after a first acute myocardial infarction. Am Heart J 1997; 134: 1019–1028.CrossRefGoogle ScholarPubMed
11.Bobkowski, W, Siwińska, A, Górzna, H, Niedbalski, R, Paluszak, W, Maciejewski, J.Dysrhythmias documented by 48-hours electrocardiographic monitoring in children with mitral valve prolapse. Pediatr Pol 1996; 76: 493–497.Google Scholar
12.Ohara, N, Mikajima, T, Takagi, J, Kato, H.Mitral valve prolapse in childhood: the incidence and clinical presentations in different age groups. Acta Pediatr Jpn 1991; 33: 467–475.CrossRefGoogle ScholarPubMed
13.DeMaria, AN, Amsterdam, EA, Vismara, LA, Neumann, A, Mason, DT.Arrhythmias in the mitral valve prolapse syndrome. Prevalence, nature, and frequency. Ann Intern Med 1976; 84: 656–660.Google ScholarPubMed
14.Kramer, HM, Kligfield, P, Devereux, RB, Savage, DD, Kramer-Fox, R.Arrhythmias in mitral valve prolapse. Effect of selection bias. Arch Intern Med 1984; 144: 2360–2364.CrossRefGoogle ScholarPubMed
15.Savage, DD, Levy, D, Garrison, RJ et al. , Mitral valve prolapse in the general population. 3. Dysrhythmias: the Framingham study. Am Heart J 1983; 106: 582–586.CrossRefGoogle ScholarPubMed
16.Kligfield, P, Hochreiter, C, Kramer, H et al. , Complex arrhythmias in mitral regurgitation with and without mitral valve prolapse: contrast to arrhythmias in mitral valve prolapse without mitral regurgitation. Am J Cardiol 1985; 55: 1545–1549.CrossRefGoogle ScholarPubMed
17.Jabi, H, Burger, AJ, Orawiec, B, Touchon, RC.Late potentials in mitral valve prolapse. Am Heart J 1991; 122: 1340–1345.CrossRefGoogle ScholarPubMed
18.Banasiak, W, Pająk, I, Ponikowski, P, Więch, K, Łacheta, W, Telichowski, C.Recording of atrial and ventricular signal-averaged ECG in patients with mitral valve prolapse syndrome. Pol Merk Lek 1998; 4: 302–305.Google ScholarPubMed
19.Costa, AM, Maia, IG, Cruz-Filho, F, Fagundes, ML, Sa, R, Alves, P.Relationship between mitral valve prolapse and arrhythmogenic right ventricular disease. Arq Bras Cardiol 1996; 67: 379–383.Google ScholarPubMed
20.Burke, AP, Farb, A, Tang, A, Smialek, J, Virmani, R.Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular in mitral valve prolapse. Am Heart J 1997; 134: 282–289.CrossRefGoogle ScholarPubMed
21.Nakada, T, Yonesaka, S.Histopathologic evidence for cardiomyopathy in a child with mitral valve prolapse. Acta Pediatr Jpn 1993; 35: 525–528.CrossRefGoogle Scholar
22.Tamura, K, Fukuda, Y, Ishizaki, M, Masuda, Y, Yamanaka, N, Ferrans, VJ.Abnormalities in elastic fibres and other connectivetissue components of floppy mitral valve. Am Heart J 1995; 129: 1149–1158.CrossRefGoogle ScholarPubMed
23.Ronnenberger, DL, Hausmann, R, Betz, P.Sudden death associated with myxomatous transformation of the mitral valve in an 8-year-old boy. Int J Legal Med 1998; 111: 199–201.CrossRefGoogle Scholar
24.La-Vecchia, L, Ometto, R, Bedogni, F et al. , Ventricular late potentials, interstinal fibrosis, and right ventricular function in patients with ventricular tachycardia and normal left ventricular function. Am J Cardiol 1998; 81: 790–792.CrossRefGoogle Scholar