Premature ventricular complexes increase with heart rate in patients with mitral valve prolapse

Background: Patients with mitral valve prolapse (MVP) are at risk of ventricular arrhythmias (VAs), ranging from premature ventricular complexes (PVCs) to life-threatening VAs. The association between PVC burden and heart rate in patients with MVP is not known. We aimed to identify the association between PVC burden and heart rate in patients with MVP. Methods: In this this cross-sectional ambispective case control study we included MVP patients with available Holter monitorings. We defined PVC profiles as fast-heart-rate-dependent-PVC (F-HR-PVC) in case of positive correlation with heart rate, slow-heart-rate-dependent-PVC (S-HR-PVC) in case of negative correlation, and independent-heart-rate-PVC (I-HR-PVC) when no correlation was found. For comparison, we included a control group of age- and sex-matched patients with idiopathic PVCs. Results: We included 70 patients with MVP (48 years [interquartile range 35-58], 79% female) and 70 age- and sex-matched patients with idiopathic PVCs. A total of 153 Holter monitorings from patients with MVP were analysed and compared to 70 Holter monitorings from patients with idiopathic PVCs. In the MVP group, we found F-HR-PVC in 44 (63%) patients, I-HR-PVC in 24 (34%) and S-HR-PVC in 2 (3%). MVP patients had more frequently F-HR-PVC and less frequently S-HR-PVC than the control group (p < 0.05 for both). MVP patients with F-HR-PVC had higher rate of NSVTs (incidence rate ratio 2.9 [95% confidence interval 1.1-7.8], p = 0.03) compared to I-HR-PVC. Conclusion: Fast-heart-rate-dependent-PVC was the most common PVC profile in MVP patients, and slow-heart-rate-dependent-PVC was rare. These findings suggest a catecholamine-sensitive mechanism acting as trigger for ventricular arrhythmias in MVP patients.