Ventricular Arrhythmias in Patients Undergoing Mitral Valve Surgery

Prospective explorative observational study in which the impact of mitral valve surgery for mitral regurgitation on ventricular arrhytmias and CMR imaging biomarkers will be examined in patients with arrhythmogenic MVP compared to those without arrhythmogenic MVP (controls). Molecular phenotyping of endocardial biopsies in patients with and without arrhythmogenic MVP will be performed as well as molecular phenotyping of the myxomatous disease in explanted valves by means of deep RNA single cell sequencing. Using CMR in 90 patients with MVP before and 6 months after mitral valve surgery, the presence and type (reversible vs irreversible) of papillary muscle and cardiac fibrosis will be characterized. To assess change in ventricular arrhytmic burden after surgery, patients will undergo continuous seven day monitoring with E-patch at baseline and at 6 months after mitral valve surgery. During surgery, explanted mitral valves (in patients undergoing replacement) as well as endocardial biopsies will be collected.

Inclusion criteria

• Age 18 and over
• Patients with and without (controls) arrhythmogenic MVP in need of mitral valve surgery for primary mitral regurgitation according to current standard of care

Exclusion criteria

• Secondary mitral regurgitation
• Primary mitral regurgitation not due to degenerative disease (including rheumatic disease)
• Co-existing moderate or severe aortic valve disease
• Congenital heart disease
• Inherited or acquired cardiomyopathy
• Non-incidental or symptomatic coronary artery disease
• Uncontrolled atrial fibrillation (resting heart rate > 100/min)
• Pregnancy
• Unable to undergo CMR