Pronounced Mitral Annular Disjunction Is Associated with Increased Ventricular Arrhythmia Burden After Mitral Valve Surgery

Mitral annular disjunction (MAD) has been associated with ventricular arrhythmias in mitral valve prolapse, while postoperative ventricular arrhythmia burden remains incompletely characterized. We aimed to assess objective ventricular arrhythmia burden after mitral valve surgery in patients with and without pronounced MAD (pMAD). In this retrospective single-center cohort with cross-sectional postoperative rhythm assessment, patients undergoing mitral valve surgery for Barlow’s disease between 2014 and 2023 were stratified by intraoperative transesophageal echocardiography into pMAD (≥8 mm) and non-pMAD (<8 mm). All patients were invited to structured postoperative follow-up, including 24-h Holter monitoring at variable time points after surgery. Valid recordings were available in 126 of 246 patients (51.2%; 66 pMAD, 60 non-pMAD). Patients with pMAD had a significantly higher ventricular ectopic burden than those without pMAD (median 20.1 vs. 5.5 VES/h; p = 0.005). Non-sustained ventricular tachycardia was documented exclusively in the pMAD group (15.2% vs. 0%; p = 0.001). After multivariable adjustment, pMAD remained associated with high ventricular ectopic burden (OR 3.38, 95% CI 1.32–8.64; p = 0.011). These findings identify pMAD as a marker of increased postoperative ventricular arrhythmia burden after mitral valve surgery for Barlow’s disease.