CONGRESS ABSTRACT

This clinical case concerns a 55-year-old male patient who first presented in 2020 with irregular palpitations and ventricular ectopy. He was referred to a cardiologist, who performed diagnostic tests, including ECG, echocardiography, and 24-hour Holter. Key findings included posterior mitral leaflet prolapse with moderate mitral regurgitation (MR) and frequent monomorphic ventricular ectopic beats (VEBs), with a distinctive right bundle branch block (RBBB) morphology, occasionally in trigeminy. Holter monitoring showed an arrhythmic burden >5%. Coronary angiography ruled out significant coronary artery disease.Despite beta-blocker therapy, the palpitations worsened, and the arrhythmias became symptomatic. An electrophysiological study (EPS) was planned, and prior to the procedure, cardiac MRI  revealed late gadolinium enhancement (LGE) in the basal inferior wall and posterolateral papillary muscle, mitral annular disjunction (MAD), and bileaflet mitral valve prolapse, leading to moderate MR. The patient underwent successful catheter ablation (CA) of the VEBs, resulting in a significant reduction of arrhythmic burden. One year later, the patient presented to the emergency department with palpitations. ECG showed sustained ventricular tachycardia (VT), rapidly progressing to cardiac arrest. After resuscitation (CPR), the patient was transferred to the intensive care unit (ICU) for stabilization. Echocardiography revealed no regional wall motion abnormalities but showed moderately depressed global left ventricular function (EF 45%) and moderate MR, consistent with bileaflet mitral valve prolapse and MAD. Due to his clinical instability and high risk of further arrhythmic events, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention of fatal arrhythmias.