I brought this up in another thread but the topic is sort of lost there and it may be interesting and relevant to many of us. Mitral Valve Prolapse is common and usually not considered something to be concerned about or treated...unless it becomes severe with severe regurgitation. Mine was mild when first discovered many years ago and monitored with the occasional echo. But in 2019 when I was being worked up for an ablation with Dr. Natale, he asked for another echo and it showed severe regurgitation. I sought treatment and it was repaired with a MitraClip but, at the time, I didn't realize the implications.
I finally had that ablation last week and Dr. Natale found moderate atrial scarring. He had warned me that because of mitral valve disease, he expected that he would need to do a more aggressive ablation--which he did with 62 minutes of burning and LAA isolation. Reading up on the relation of mitral valve regurgitation and atrial scarring, I found this article:
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Atrial Fibrillation and Mitral Valve Prolapse: Time to Intervene?[/quote[
www.ncbi.nlm.nih.gov]
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Atrial fibrillation (AF) is a common sequela of degenerative mitral regurgitation (DMR) and is frequently present in patients referred for surgery for DMR.(1) DMR may lead to the development of AF via left atrial (LA) volume and pressure overload, progressive atrial fibrosis, LA enlargement, and electroanatomic remodeling.(2–5) Progressive LA enlargement and remodeling – hallmarks of long-standing DMR – promote AF substrate by affecting cell coupling, altering conduction velocity, and promoting reentry.(6)...Surgery may prevent the progression of scar formation in the atrium but is not expected to eliminate fibrosis generated by DMR-induced pressure and volume overload. In fact, once AF develops, it probably leads to an increasing degree of fibrosis - AF begets AF- which in turn results in increased substrate for AF.(30) This vicious cycle is likely to lead to continued worsening of the AF burden despite valve surgery and to reduce survival compared with patients free of AF, as described above...The presence of AF in patients with DMR is currently rated as a class IIa recommendation for MV surgery in the both American and European guidelines on valvular heart disease.(17,18) A class I recommendation can be applied when there is strong supportive evidence that a treatment option is beneficial, even if obtained from a non-randomized study (i.e., class I, level cool smiley. Given the strength of the above evidence from Grigioni and colleagues, it may be time to re-evaluate the guidelines regarding the presence of AF in DMR patients.
As I am reading this, it would seem that having mitral valve regurgitation together with Afib, makes mitral valve repair more urgent than previously thought. Perhaps had my mitral valve been repaired earlier, I would not have developed so much fibrosis and thus such a substrate for Afib. When I was evaluated for mitral valve repair, the threshold was severe regurgitation but by that time a lot of fibrosis many have already developed. If you have mitral valve prolapse this may be something to explore with your cardiologist or EP.
