Complex Ventricular Arrhythmias in Patients with Mitral Annular Disjunction: A Systematic Review and Meta‐Analysis

Mitral annular disjunction (MAD) frequently co-occurs with mitral valve prolapse (MVP). It is unclear, however, whether MAD is associated with an additional risk of arrhythmogenic events in patients with MVP. We aimed to evaluate the incidence of complex ventricular arrhythmias (VA) and sudden cardiac death (SCD) in patients with MAD compared to those without MAD. We systematically searched PubMed, Embase, and Web of Science for studies evaluating the incidence of complex VA and the composite outcome of complex VA and SCD among patients with versus without MAD. We performed a random-effects meta-analysis to pool odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals. We included 16 studies comprising 6001 patients, of whom 23% had MAD; 41% were female; the mean age was 56.5 years. MVP was significantly present in both groups, with a higher prevalence in the MAD group in 1030 patients (74.5%) with MAD and in 1942 patients (47%) without MAD. The incidence of complex VA was significantly higher in patients with MAD (OR 3.88; 95% CI 1.69-8.93; p = 0.001), compared with patients without MAD. Patients with MAD also had a higher risk of the composite outcome of complex VA and SCD (HR 2.51; 95% CI 1.94-3.24; p < 0.00001) (OR 3.13; 95% CI 1.38-7.11; p = 0.006). In this meta-analysis, the presence of MAD was significantly associated with the development of complex VA and the composite outcome of complex VA and SCD. The outcome of SCD was not evaluated as an isolated endpoint.