1. Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation
- Author
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Jadranka Stojanovska, Hakan Oral, Konstantinos C. Siontis, Krit Jongnarangsin, Fred Morady, Frank Pelosi, Hyungjin Myra Kim, Miki Yokokawa, Rakesh Latchamsetty, Frank Bogun, Ryan Cunnane, Hamid Ghanbari, Aman Chugh, and Thomas Crawford
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Radiofrequency ablation ,Heart Ventricles ,medicine.medical_treatment ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,law.invention ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,law ,Cardiac magnetic resonance imaging ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Stroke Volume ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Implantable cardioverter-defibrillator ,Ventricular Premature Complexes ,Defibrillators, Implantable ,Preoperative Period ,Ventricular fibrillation ,Catheter Ablation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - 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 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.
- Published
- 2017