Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation

• Published in: Heart rhythm Vol. 14; no. 11; pp. 1695 - 1701
• Main Authors: Yokokawa, Miki, Siontis, Konstantinos C., Kim, Hyungjin Myra, Stojanovska, Jadranka, Latchamsetty, Rakesh, Crawford, Thomas, Jongnarangsin, Krit, Ghanbari, Hamid, Cunnane, Ryan, Chugh, Aman, Pelosi, Frank, Oral, Hakan, Morady, Fred, Bogun, Frank
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Cardiac magnetic resonance imaging; Catheter Ablation - methods; Defibrillators, Implantable; Female; Follow-Up Studies; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Premature ventricular complex; Preoperative Period; Programmed ventricular stimulation; Prospective Studies; Reproducibility of Results; Risk stratification; Stroke Volume - physiology; Structural heart disease; Time Factors; Ventricular Premature Complexes - diagnosis; Ventricular Premature Complexes - physiopathology; Ventricular Premature Complexes - therapy; Ventricular tachycardia; ARVC/D; MRI; Ventricular tachycardia; LV; ICD; IQR; LGE; SHD; Premature ventricular complex; Structural heart disease; VF; SCD; Risk stratification; Programmed ventricular stimulation; PVC; Cardiac magnetic resonance imaging; VT
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2017.06.040

Frequent premature ventricular complexes (PVCs) have been associated with increased mortality. However, the optimal approach to the risk stratification of these patients is unclear.
The purpose of this study was to prospectively assess the use of cardiac magnetic resonance imaging (MRI) and programmed ventricular stimulation to identify patients with PVCs undergoing radiofrequency ablation at risk for adverse long-term outcomes.
A total of 321 consecutive patients (52 ± 15 years; 157 men [49%]; left ventricular ejection fraction 51% ± 12%) underwent PVC ablation between 2004 and 2015, preceded by cardiac MRI to assess for structural heart disease (SHD). Programmed stimulation was performed at the time of the ablation procedure. If ventricular tachycardia (VT) was induced in the presence of SHD, an implantable cardioverter-defibrillator (ICD) was implanted.
SHD was identified by MRI in 64 patients (20%), and sustained monomorphic VT was inducible in 15 patients (5%). Fourteen patients had both SHD and inducible VT, and received an ICD after the procedure. The primary endpoint of VT/ventricular fibrillation or death was met in 15 patients after a median 20 months of follow-up. The combination of SHD by MRI and VT inducibility conferred independently an increased risk of adverse outcome (multivariate hazard ratio 25.73, 95% confidence interval 6.74–98.20; P <.001).
Preablation cardiac MRI and programmed stimulation can be useful for risk stratification in patients with frequent PVCs. Patients with inducible VT in the setting of SHD may benefit from ICD implantation after ablation regardless of left ventricular ejection fraction.