This week we review the topic of mitral annular disjunction ("MAD") and the possible association with ventricular arrhythmia or sudden death in the connective tissue disease patient. Is there a 'cut off' distance above which patients deserve more significant arrhythmia surveillance? What is the best way to measure the MAD distance? Can patients with low MAD distances have lower degrees or even no arrhythmic surveillance? How often should this distance be measured on CMR and can an echo measurement provide similar data? Dr. Daniel Castellanos, the first author of this work and Assistant Professor of Pediatrics at Harvard Medical School shares his deep insights this week.

• DOI: 10.1016/j.jocmr.2025.101954