{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:40:33Z","timestamp":1790887233243,"version":"4.1.0"},"reference-count":114,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive\/leisure-time sports, envisioning shared decision making and the multidisciplinary \u201csports heart team\u201d evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients\u2019 safety.<\/jats:p>","DOI":"10.3390\/jcm13051350","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T11:52:55Z","timestamp":1709034775000},"page":"1350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"first","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina","family":"Selimi","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7570-4278","authenticated-orcid":false,"given":"Laura","family":"Cipolletta","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Volpato","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Gasperetti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Department of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0454-0739","authenticated-orcid":false,"given":"Yari","family":"Valeri","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quintino","family":"Parisi","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3213-4436","authenticated-orcid":false,"given":"Antonio","family":"Curcio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St David\u2019s Medical Center, Austin, TX 78705, USA"},{"name":"Interventional Electrophysiology, Scripps Clinic, San Diego, CA 92037, USA"},{"name":"Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-1742","authenticated-orcid":false,"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"},{"name":"Department of Medical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and clinical outcome of mitral-valve prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: A population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"ref_3","first-page":"511","article-title":"Prevalence of mitral valve prolapse in ethnic groups","volume":"20","author":"Theal","year":"2004","journal-title":"Can. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101724","DOI":"10.1016\/j.cpcardiol.2023.101724","article-title":"Arrhythmogenic Mitral Valve Prolapse and Sudden Cardiac Death: An Update and Current Perspectives","volume":"48","author":"Battaglia","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1093\/europace\/euac125","article-title":"EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed by the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society","volume":"24","author":"Sabbag","year":"2022","journal-title":"Europace"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1093\/ehjci\/jez153","article-title":"Anatomy of mitral annulus insights from non-invasive imaging techniques","volume":"20","author":"Faletra","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/S0735-1097(02)02161-7","article-title":"Mitral valve prolapse in the general population: The benign nature of echocardiographic features in the Framingham Heart Study","volume":"40","author":"Freed","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1161\/01.CIR.0000028933.34260.09","article-title":"Natural history of asymptomatic mitral valve prolapse in the community","volume":"106","author":"Avierinos","year":"2002","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1161\/CIRCULATIONAHA.117.033173","article-title":"Clinical Outcome of Degenerative Mitral Regurgitation: Critical Importance of Echocardiographic Quantitative Assessment in Routine Practice","volume":"138","author":"Antoine","year":"2018","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"ESC\/EACTS Scientific Document Group. 2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_11","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/0002-8703(66)90179-7","article-title":"Aneurysmal protrusion of the posterior leaflet of the mitral valve. An auscultatory-electrocardiographic syndrome","volume":"71","author":"Barlow","year":"1966","journal-title":"Am. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJM198511213132101","article-title":"Echocardiographically documented mitral-valve prolapse. Long-term follow-up of 237 patients","volume":"313","author":"Nishimura","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/0735-1097(88)90164-7","article-title":"Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: A prospective study","volume":"11","author":"Becker","year":"1988","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.hrthm.2015.09.026","article-title":"Mitral valve prolapse and sudden cardiac arrest in the community","volume":"13","author":"Narayanan","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1161\/CIRCULATIONAHA.118.034075","article-title":"Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death","volume":"140","author":"Basso","year":"2019","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1016\/S0735-1097(99)00474-X","article-title":"Sudden death in mitral regurgitation due to flail leaflet","volume":"34","author":"Grigioni","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1136\/heartjnl-2017-312932","article-title":"Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis","volume":"105","author":"Nalliah","year":"2019","journal-title":"Heart"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death","volume":"132","author":"Basso","year":"2015","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.jacep.2021.01.007","article-title":"Antemortem and Post-Mortem Characteristics of Lethal Mitral Valve Prolapse Among All Countywide Sudden Deaths","volume":"7","author":"Delling","year":"2021","journal-title":"JACC Clin Electrophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/S0008-6363(01)00261-9","article-title":"Postmortem diagnosis in sudden cardiac death victims: Macroscopic, microscopic and molecular findings","volume":"50","author":"Basso","year":"2001","journal-title":"Cardiovasc. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1161\/CIRCULATIONAHA.117.033395","article-title":"Prevalence and Clinical Outcome of Athletes with Mitral Valve Prolapse","volume":"137","author":"Caselli","year":"2018","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.jacc.2016.02.062","article-title":"Etiology of Sudden Death in Sports: Insights from a United Kingdom Regional Registry","volume":"67","author":"Finocchiaro","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.amjmed.2016.02.031","article-title":"Demographics and Epidemiology of Sudden Deaths in Young Competitive Athletes: From the United States National Registry","volume":"129","author":"Maron","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/0002-8703(91)90727-Y","article-title":"Sports-related and non-sports-related sudden cardiac death in young adults","volume":"121","author":"Burke","year":"1991","journal-title":"Am. Heart J."},{"key":"ref_26","first-page":"641","article-title":"Nontraumatic sports death in high school and college athletes","volume":"27","author":"Bloor","year":"1995","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1001\/jama.1996.03540030033028","article-title":"Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles","volume":"276","author":"Maron","year":"1996","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1161\/CIRCULATIONAHA.108.804617","article-title":"Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980\u20132006","volume":"119","author":"Maron","year":"2009","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1016\/j.jacc.2014.01.041","article-title":"Incidence and causes of sudden death in U.S. college athletes","volume":"63","author":"Maron","year":"2014","journal-title":"J. Am. Coll Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"euad309","DOI":"10.1093\/europace\/euad309","article-title":"Lifetime exercise dose and ventricular arrhythmias in patients with mitral valve prolapse","volume":"25","author":"Five","year":"2023","journal-title":"Europace"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.tcm.2021.06.001","article-title":"Causes of sudden cardiac death in young athletes and non-athletes: Systematic review and meta-analysis: Sudden cardiac death in the young","volume":"32","author":"Valentini","year":"2022","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_32","first-page":"ehad491","article-title":"Arrhythmic mitral valve prolapse and mitral annular disjunction: Pathophysiology, risk stratification, and management","volume":"10","author":"Essayagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"131220","DOI":"10.1016\/j.ijcard.2023.131220","article-title":"Interpretation and management of premature ventricular beats in athletes: An expert opinion document of the Italian Society of Sports Cardiology (SICSPORT)","volume":"391","author":"Zorzi","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Muser, D., Tritto, M., Mariani, M.V., Di Monaco, A., Compagnucci, P., Accogli, M., De Ponti, R., and Guarracini, F. (2021). Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin. Diagnostics, 11.","DOI":"10.3390\/diagnostics11101840"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jacc.2020.06.029","article-title":"Presentation and Outcome of Arrhythmic Mitral Valve Prolapse","volume":"76","author":"Essayagh","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/j.jacc.2019.06.032","article-title":"Prognostic Implications of Left Atrial Enlargement in Degenerative Mitral Regurgitation","volume":"74","author":"Essayagh","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jacc.2018.10.067","article-title":"MIDA Investigators. Long-Term Implications of Atrial Fibrillation in Patients with Degenerative Mitral Regurgitation","volume":"73","author":"Grigioni","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2904","DOI":"10.1016\/j.jacc.2018.09.048","article-title":"Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week","volume":"72","author":"Miller","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","first-page":"e005030","article-title":"Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse","volume":"9","author":"Basso","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.jacc.2018.06.048","article-title":"Myocardial Fibrosis in Patients with Primary Mitral Regurgitation with and without Prolapse","volume":"72","author":"Kitkungvan","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1161\/CIRCULATIONAHA.120.050214","article-title":"Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling, and Arrhythmia","volume":"143","author":"Huttin","year":"2021","journal-title":"Circulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.hroo.2023.08.003","article-title":"Genetic mechanisms underlying arrhythmogenic mitral valve prolapse: Current and future perspectives","volume":"4","author":"Levy","year":"2023","journal-title":"Heart Rhythm O2"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Villatore, A., Sala, S., Stella, S., Vignale, D., Busnardo, E., Esposito, A., Basso, C., Della Bella, P., Mazzone, P., and Peretto, G. (2021). Autoimmune Myocarditis and Arrhythmogenic Mitral Valve Prolapse: An Unexpected Overlap Syndrome. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8110151"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.jacep.2022.10.032","article-title":"Inflammation on Endomyocardial Biopsy Predicts Risk of MACE in Undefined Left Ventricular Arrhythmogenic Cardiomyopathy","volume":"9","author":"Peretto","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Compagnucci, P., Volpato, G., Falanga, U., Cipolletta, L., Conti, M.A., Grifoni, G., Ciliberti, G., Stronati, G., Fogante, M., and Bergonti, M. (2021). Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update. Medicina, 57.","DOI":"10.3390\/medicina57030277"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jacep.2022.10.004","article-title":"Different Phases of Disease in Lymphocytic Myocarditis: Clinical and Electrophysiological Characteristics","volume":"9","author":"Casella","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e008774","DOI":"10.1161\/CIRCEP.120.008774","article-title":"Impact of the COVID-19 Pandemic on a Tertiary-Level Electrophysiology Laboratory in Italy","volume":"13","author":"Compagnucci","year":"2020","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0008-6363(99)00390-9","article-title":"Mechano-electrical feedback","volume":"45","author":"Franz","year":"2000","journal-title":"Cardiovasc. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1161\/01.CIR.73.5.1013","article-title":"Electrophysiologic effects of papillary muscle traction in the intact heart","volume":"73","author":"Gornick","year":"1986","journal-title":"Circulation"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1111\/jce.15898","article-title":"Implantable defibrillator-detected heart failure status predicts ventricular tachyarrhythmias","volume":"34","author":"Compagnucci","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.ijcard.2016.06.252","article-title":"Ventricular premature contraction associated with mitral valve prolapse","volume":"221","author":"Zhong","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e004005","DOI":"10.1161\/CIRCEP.116.004005","article-title":"Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome","volume":"9","author":"Syed","year":"2016","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10840-020-00775-1","article-title":"Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse","volume":"61","author":"Marano","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/jce.12478","article-title":"Ventricular fibrillation triggered by PVCs from papillary muscles: Clinical features and ablation","volume":"25","author":"Santoro","year":"2014","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.hrthm.2022.09.008","article-title":"Characterization of ventricular arrhythmias and sudden cardiac death in subjects with mitral valve prolapse and mitral annular disjunction","volume":"20","author":"Raina","year":"2023","journal-title":"Heart Rhythm."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1161\/01.CIR.86.3.968","article-title":"Electrophysiological effects of myocardial stretch and mechanical determinants of stretch-activated arrhythmias","volume":"86","author":"Franz","year":"1992","journal-title":"Circulation"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jjcc.2014.07.020","article-title":"Floppy mitral valve\/mitral valve prolapse syndrome: Beta-adrenergic receptor polymorphism may contribute to the pathogenesis of symptoms","volume":"65","author":"Theofilogiannakos","year":"2015","journal-title":"J. Cardiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Volpato, G., Falanga, U., Cipolletta, L., Conti, M.A., Grifoni, G., Ciliberti, G., Urbinati, A., Barbarossa, A., Stronati, G., and Fogante, M. (2021). Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases. Medicina, 57.","DOI":"10.3390\/medicina57040308"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1161\/CIRCULATIONAHA.116.022535","article-title":"Cardiovascular Effects of Performance-Enhancing Drugs","volume":"135","author":"Brosnan","year":"2017","journal-title":"Circulation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_61","unstructured":"Comitato Organizzativo Cardiologico per l\u2019idoneit\u00e0 allo Sport (2023). Protocolli Cardiologici Per Il Giudizio Di Idoneit\u00e0 Allo Sport Agonistico, CESI. [6th ed.]."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1177\/2047487320941646","article-title":"How to manage an athlete with mitral valve prolapse","volume":"28","author":"Cavarretta","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/2047487319874148","article-title":"Familial occurrence of mitral regurgitation in patients with mitral valve prolapse undergoing mitral valve surgery","volume":"27","author":"Hiemstra","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Chakrabarti, A.K., Bogun, F., and Liang, J.J. (2022). Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9020061"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e010584","DOI":"10.1161\/JAHA.118.010584","article-title":"Mitral Valve Prolapse and Sudden Cardiac Death: A Systematic Review","volume":"7","author":"Han","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jacc.2013.02.060","article-title":"Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest","volume":"62","author":"Sriram","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1080\/00015385.2023.2227487","article-title":"High-risk phenotypes of arrhythmic mitral valve prolapse: A systematic review and meta-analysis","volume":"78","author":"Benjanuwattra","year":"2023","journal-title":"Acta Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"3179","DOI":"10.1111\/jce.15270","article-title":"Characterization of the electrophysiological substrate in patients with Barlow\u2019s disease","volume":"32","author":"Vergara","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1111\/jce.13900","article-title":"Papillary muscle ventricular arrhythmias in patients with arrhythmic mitral valve prolapse: Electrophysiologic substrate and catheter ablation outcomes","volume":"30","author":"Enriquez","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1093\/europace\/euac182","article-title":"Ventricular arrhythmias in arrhythmic mitral valve syndrome-a prospective continuous long-term cardiac monitoring study","volume":"25","author":"Aabel","year":"2023","journal-title":"Europace"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/joa3.12062","article-title":"Signal-averaged electrocardiography: Past, present, and future","volume":"34","author":"Gatzoulis","year":"2018","journal-title":"J. Arrhythm."},{"key":"ref_72","first-page":"433","article-title":"Studio dei potenziali tardivi in pazienti con prolasso della valvola mitrale [Late potentials in patients with prolapse of the mitral valve]","volume":"39","author":"Bertoni","year":"1991","journal-title":"Minerva Cardioangiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/0002-8703(91)90575-3","article-title":"Late potentials in mitral valve prolapse","volume":"122","author":"Jabi","year":"1991","journal-title":"Am. Heart J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1111\/j.1540-8159.1994.tb01466.x","article-title":"Ventricular arrhythmia factors in mitral valve prolapse","volume":"17","author":"Babuty","year":"1994","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_75","first-page":"957","article-title":"Relazione tra potenziali tardivi ventricolari e aritmie ventricolari nel prolasso valvolare mitralico [Relations between ventricular late potentials and ventricular arrhythmias in mitral valve prolapse]","volume":"24","author":"Maraglino","year":"1994","journal-title":"G. Ital. Cardiol."},{"key":"ref_76","first-page":"62","article-title":"Signal averaged electrocardiogram after exercise in patients with mitral valve prolapse","volume":"28","author":"Nomura","year":"1997","journal-title":"J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/00149831-200410000-00013","article-title":"Non-invasive cardiac electrophysiological indices in soccer players with mitral valve prolapse","volume":"11","author":"Koutlianos","year":"2004","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1093\/eurheartj\/ehz260","article-title":"Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: The PRESERVE EF study","volume":"40","author":"Gatzoulis","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.hjc.2020.03.008","article-title":"ReCONSIDER study Investigators. Arrhythmic risk stratification in nonischemic dilated cardiomyopathy: The ReCONSIDER study design\u2014A two-step, multifactorial, electrophysiology-inclusive approach","volume":"62","author":"Gatzoulis","year":"2021","journal-title":"Hellenic J. Cardiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1161\/01.CIR.0000129762.41889.41","article-title":"Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community: The Framingham Heart Study","volume":"109","author":"Evans","year":"2004","journal-title":"Circulation"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1016\/j.jacc.2021.09.1366","article-title":"Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals","volume":"78","author":"Refaat","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1056\/NEJMoa022353","article-title":"Frequent ventricular ectopy after exercise as a predictor of death","volume":"348","author":"Frolkis","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1093\/eurheartj\/ehad017","article-title":"Value of screening for the risk of sudden cardiac death in young competitive athletes","volume":"44","author":"Sarto","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Scientific Document Committee of the European Association of Cardiovascular Imaging. Multi-modality imaging assessment of native valvular regurgitation: An EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"van Wijngaarden, A.L., Kruithof, B.P.T., Vinella, T., Barge-Schaapveld, D.Q.C.M., and Ajmone Marsan, N. (2021). Characterization of Degenerative Mitral Valve Disease: Differences between Fibroelastic Deficiency and Barlow\u2019s Disease. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8020023"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/j.jcmg.2021.04.029","article-title":"The Mitral Annular Disjunction of Mitral Valve Prolapse: Presentation and Outcome","volume":"14","author":"Essayagh","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1111\/pace.14338","article-title":"Arrhythmic mitral valve prolapse: Diagnostic parameters for high-risk patients: A systematic review and meta-analysis","volume":"44","author":"Oliveri","year":"2021","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.jcmg.2016.09.016","article-title":"The Pickelhaube Sign: Novel Echocardiographic Risk Marker for Malignant Mitral Valve Prolapse Syndrome","volume":"10","author":"Muthukumar","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jcmg.2008.01.013","article-title":"Cardiovascular magnetic resonance characterization of mitral valve prolapse","volume":"1","author":"Han","year":"2008","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1136\/heartjnl-2016-309303","article-title":"Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia","volume":"103","author":"Bui","year":"2017","journal-title":"Heart"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.jacc.2018.07.070","article-title":"The Mitral Annulus Disjunction Arrhythmic Syndrome","volume":"72","author":"Dejgaard","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ijcard.2023.05.013","article-title":"Electroanatomic mapping in athletes: Why and when. An expert opinion paper from the Italian Society of Sports Cardiology","volume":"383","author":"Compagnucci","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1161\/CIRCULATIONAHA.122.060866","article-title":"Programmed Ventricular Stimulation as an Additional Primary Prevention Risk Stratification Tool in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Study","volume":"146","author":"Gasperetti","year":"2022","journal-title":"Circulation"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e011088","DOI":"10.1161\/CIRCEP.122.011088","article-title":"Substrate Characterization and Outcomes of Catheter Ablation of Ventricular Arrhythmias in Patients with Mitral Annular Disjunction","volume":"15","author":"Ezzeddine","year":"2022","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.jacep.2023.02.010","article-title":"Mitral Annular Substrate and Ventricular Arrhythmias in Arrhythmogenic Mitral Valve Prolapse with Mitral Annular Disjunction","volume":"9","author":"Chakrabarti","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e021370","DOI":"10.1161\/JAHA.121.021370","article-title":"Endomyocardial Biopsy: The Forgotten Piece in the Arrhythmogenic Cardiomyopathy Puzzle","volume":"10","author":"Casella","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.hrthm.2021.09.013","article-title":"Ventricular arrhythmias in athletes: Role of a comprehensive diagnostic workup","volume":"19","author":"Compagnucci","year":"2022","journal-title":"Heart Rhythm."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e201222212066","DOI":"10.2174\/1573403X19666221220163431","article-title":"Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk","volume":"19","author":"Vriz","year":"2023","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_101","first-page":"419","article-title":"Il metoprololo nel trattamento della fibrillazione atriale: Stato dell\u2019arte [Metoprolol for atrial fibrillation: State of the art]","volume":"23","author":"Capucci","year":"2022","journal-title":"G Ital. Cardiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.hrthm.2022.12.024","article-title":"Flecainide in patients with arrhythmic mitral valve syndrome: A case series","volume":"20","author":"Aabel","year":"2023","journal-title":"Heart Rhythm."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/pace.13613","article-title":"Management and outcomes in mitral valve prolapse with ventricular arrhythmias undergoing ablation and\/or implantation of ICDs","volume":"42","author":"Bumgarner","year":"2019","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/jce.13338","article-title":"The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle","volume":"29","author":"Peichl","year":"2018","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1111\/pace.13363","article-title":"Catheter ablation of papillary muscle arrhythmias: Implications of mitral valve prolapse and systolic dysfunction","volume":"41","author":"Lee","year":"2018","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/joa3.12137","article-title":"Updated results on catheter ablation of ventricular arrhythmias arising from the papillary muscles of the left ventricle","volume":"35","author":"Rivera","year":"2018","journal-title":"J. Arrhythm."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1111\/jce.15908","article-title":"Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: A dual-center experience","volume":"34","author":"Compagnucci","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Compagnucci, P., Valeri, Y., Conti, S., Volpato, G., Cipolletta, L., Parisi, Q., D\u2019Angelo, L., Campanelli, F., Carboni, L., and Sgarito, G. (J. Interv. Card. Electrophysiol., 2023). Technological advances in ventricular tachycardia catheter ablation: The relentless quest for novel solutions to old problems, J. Interv. Card. Electrophysiol., Online ahead of print.","DOI":"10.1007\/s10840-023-01705-7"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1093\/europace\/euz132","article-title":"ESC Scientific Document Group. 2019 HRS\/EHRA\/APHRS\/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias","volume":"21","author":"Cronin","year":"2019","journal-title":"Europace"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.hrthm.2022.02.029","article-title":"Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter-defibrillators: A propensity-matched analysis from a multicenter European registry","volume":"19","author":"Gulletta","year":"2022","journal-title":"Heart Rhythm."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s10840-015-0090-5","article-title":"Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse","volume":"46","author":"Vaidya","year":"2016","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ipej.2016.10.009","article-title":"The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse","volume":"16","author":"Naksuk","year":"2016","journal-title":"Indian. Pacing Electrophysiol. J."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1540-8159.1993.tb01599.x","article-title":"Malignant ventricular arrhythmias in patients with mitral valve prolapse and mild mitral regurgitation","volume":"16","author":"Vohra","year":"1993","journal-title":"Pacing Clin. Electrophysiol"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"ivad073","DOI":"10.1093\/icvts\/ivad073","article-title":"The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow\u2019s disease: Preliminary results of a prospective study","volume":"36","author":"Ascione","year":"2023","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1350\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:05:41Z","timestamp":1760105141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,27]]},"references-count":114,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13051350"],"URL":"https:\/\/doi.org\/10.3390\/jcm13051350","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,27]]}}}