Role of Cardiac Magnetic Resonance in the Assessment of Patients with Premature Ventricular Contractions: A Narrative Review

Abstract

Premature ventricular contractions (PVCs) are a common finding in clinical practice, requiring a full diagnostic work-up in order to exclude an underlying cardiomyopathy. Still, in a substantial proportion of patients, these investigations do not identify any substrate, and the PVCs are labelled as idiopathic. Cardiac magnetic resonance (CMR) has proven in the last decades as the method of choice for the exploration of patients with cardiomyopathies, since it can identify subtle changes in the myocardial tissue and help with risk stratification. In patients with idiopathic PVCs and a high PVC burden, several studies report the presence of late gadolinium enhancement (LGE) at CMR, which can offer additional diagnostic and prognostic benefits, as well as assistance in catheter ablation procedures, as the risk for adverse cardiac and risk for arrhythmic events events is higher compared to patients without scar. This paper focuses on the impact of the presence of LGE in patients with idiopathic PVCs, reviewing all the relevant studies published so far, including randomized controlled clinical trials, prospective or retrospective cohort studies, case series and case reports as well as systematic reviews.

Figure 1.

Types of premature ventricular contractions based on origin. LVOT, left ventricle outflow tract; LV, left ventricle; RVOT, right ventricle outflow tract; RV, right ventricle.

Figure 2.

Presence of cardiac scar in the inferior and lateral walls of LV (A) and anterolateral wall (B); LV, left ventricle.

Figure 3.

Integration of CMR images for the electroanatomical mapping in a patient with PVCs originating in the RV—extensive epicardial scar tissue at the level of the RVOT.

Figure 4.

Scar analysis (from the endocardium to the epicardium) with dedicated software for the detection of the arrhythmic channels. Blue—normal tissue; red—fibrosis; green—arrhythmic channels.