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. 2021 Jan 27;11(2):178.
doi: 10.3390/diagnostics11020178.

Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging

Chrysovalantou Nikolaidou  1   2 , Konstantinos Kouskouras  3 , Nikolaos Fragakis  4 , Vassilios P Vassilikos  4 , Haralambos Karvounis  2 , Theodoros D Karamitsos  2
Affiliations

Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging

Chrysovalantou Nikolaidou et al. Diagnostics (Basel). .

Abstract

Acquiring high-quality cardiac magnetic resonance (CMR) images in patients with frequent ventricular arrhythmias remains a challenge. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning to suppress ventricular ectopy and acquire high-quality images. Fifty consecutive patients (age 53.0 [42.0-58.0]; 52% female, left ventricular ejection fraction 55 ± 9%) were scanned in a 1.5 T scanner using a standard cardiac protocol. Procainamide was administered at intermittent intravenous bolus doses of 50 mg every minute until suppression of the ectopics or a maximum dose of 10 mg/kg. The average dose of procainamide was 567 ± 197 mg. Procainamide successfully suppressed premature ventricular contractions (PVCs) in 82% of patients, resulting in high-quality images. The baseline blood pressure (BP) was mildly reduced (mean change systolic BP -12 ± 9 mmHg; diastolic BP -4 ± 9 mmHg), while the baseline heart rate (HR) remained relatively unchanged (mean HR change -1 ± 6 bpm). None of the patients developed proarrhythmic changes. Bolus intravenous administration of procainamide prior to CMR scanning is a safe and effective alternative approach for suppressing PVCs and acquiring high-quality images in patients with frequent PVCs and normal or only mildly reduced systolic function.

Keywords: CMR image quality; cardiac magnetic resonance; premature ventricular contractions; procainamide; ventricular arrhythmia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study protocol. In patients presenting for the Cardiac Magnetic Resonance study with frequent ventricular ectopics and significantly impaired image quality, procainamide was administered on the scanner bed at intermittent intravenous bolus doses. The result was the successful suppression of premature ventricular contractions in most of the patients and a high image quality.
Figure 2
Figure 2
Severely impaired image quality on horizontal long-axis cardiac magnetic resonance cine imaging in a patient with a high ectopic burden (A), in contrast to the high-quality images after premature ventricular contraction (PVC) suppression with intravenous administration of procainamide (B). Late gadolinium enhancement image with impaired image quality of a patient with frequent PVCs (C), compared with the high-quality imaging in another patient with suppression of PVCs with procainamide (D).
See this image and copyright information in PMC

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