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  • Title: [Relations between ventricular late potentials and ventricular arrhythmias in mitral valve prolapse].
    Author: Maraglino G, Sturaro M, Toniolo G, Accurso V, Pastore G, Palatini P.
    Journal: G Ital Cardiol; 1994 Aug; 24(8):957-64. PubMed ID: 7958637.
    Abstract:
    BACKGROUND: The aim of the present study was to assess the prevalence and the clinical significance of ventricular late potentials in mitral valve prolapse. METHODS: Two hundred subjects (126 women and 74 men) with mitral valve prolapse, and a mean age of 37 +/- 17 years, were studied. Fifty eight per cent of them exhibited signs of mitral regurgitation at Doppler analysis of mitral flow. A 24-hour Holter recording and a signal-averaged electrocardiogram were performed in all the patients. Late potentials were considered present if the filtered QRS complex was > 110 ms and the root-mean-square amplitude in the last 40 ms of the filtered QRS was < 25 microV after 25 Hz filtering and respectively > 114 ms and < 20 microV after 40 Hz filtering. The duration of low-amplitude signals < 40 mV had to be > 38 ms. RESULTS: Ventricular late potentials were detected in 45 patients (22.5%) and were unrelated to subjects age, sex and electrocardiographic ST-T changes. Fourty one per cent of the subjects exhibited lown class > or = 3 ventricular extrasystoles at Holter ECG monitoring, while the remaining subjects (59%) had Lown classes < 3 ventricular arrhythmias. Complex ventricular arrhythmias were more common in the subjects who exhibited late potentials (55.5%) than in the remaining population (36.7%) (p < 0.03). A higher frequency of late potentials was found in the patients with mitral regurgitation (34.7%) than in those without (5.8%) (p < 0.0001). In the 55 subjects who manifested mitral regurgitation and complex ventricular arrhythmias, the prevalence of late potentials was 43.6%, while in the 61 without complex arrhythmias the prevalence was 26.6% (p = 0.05). CONCLUSIONS: In subjects with mitral valve prolapse the signal-averaged electrocardiogram allows to identify a subgroup of patients with more serious ventricular arrhythmias. Mitral regurgitation seems to be the main determinant of the arrhythmogenic substrate present in these patients.
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