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. 2017 Nov;14(11):1695-1701.
doi: 10.1016/j.hrthm.2017.06.040. Epub 2017 Jul 6.

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

Miki Yokokawa  1 , Konstantinos C Siontis  1 , Hyungjin Myra Kim  1 , Jadranka Stojanovska  2 , Rakesh Latchamsetty  1 , Thomas Crawford  1 , Krit Jongnarangsin  1 , Hamid Ghanbari  1 , Ryan Cunnane  1 , Aman Chugh  1 , Frank Pelosi Jr  1 , Hakan Oral  1 , Fred Morady  1 , Frank Bogun  3
Affiliations

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

Miki Yokokawa et al. Heart Rhythm. 2017 Nov.

Abstract

Background: Frequent premature ventricular complexes (PVCs) have been associated with increased mortality. However, the optimal approach to the risk stratification of these patients is unclear.

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Cardiac magnetic resonance imaging; Premature ventricular complex; Programmed ventricular stimulation; Risk stratification; Structural heart disease; Ventricular tachycardia.

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