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ECG morphology of premature ventricular contractions predicts the presence of myocardial fibrotic substrate on cardiac magnetic resonance imaging in patients undergoing ablation
Author(s) -
Oebel Sabrina,
Dinov Borislav,
Arya Arash,
Hilbert Sebastian,
Sommer Philipp,
Bollmann Andreas,
Hindricks Gerhard,
Paetsch Ingo,
Jahnke Cosima
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13309
Subject(s) - medicine , cardiology , ablation , magnetic resonance imaging , ejection fraction , cardiac magnetic resonance imaging , cardiac magnetic resonance , right bundle branch block , univariate analysis , catheter ablation , radiology , electrocardiography , heart failure , multivariate analysis
Background The most likely origin of premature ventricular contractions (PVCs) may be deduced from surface electrocardiogram (ECG) analysis while planning an electrophysiological study (EPS). Apart from purely benign forms of increased ventricular ectopy, myocardial substrate (e.g., regional fibrosis) may be present in certain cases, which will significantly impact the ablation approach. Cardiac magnetic resonance (CMR) imaging can reliably identify fibrotic target lesions and, hence, may assist in adequate patient selection and procedural planning. Methods and results We analyzed 101 patients (59% males, mean age 57.15 ± 15.5 years, mean PVC count 19,801 ± 14,021 per 24 hours) referred for ablation of PVCs. The CMR (1.5T, Philips Ingenia, Best, The Netherlands) protocol included cine and three‐dimensional‐delayed enhancement imaging using standard cardiac geometries. On surface, ECG right bundle branch block (RBBB) morphology was present in 43% of patients. Twenty‐one patients showed the fibrotic substrate on CMR. On univariate analysis, both RBBB morphology (P < 0.001) and presence of multiple PVC morphologies (≥2) significantly predicted the presence of fibrotic substrate (P = 0.01), which various baseline characteristics including left ventricular ejection fraction (45.7 ± 12.6% vs. 50.6 ± 11.0%, P = 0.08) failed to do. CMR‐identified fibrosis was associated with the site of origin of the clinical PVCs during EPS and was successfully treated by radiofrequency ablation in 93% (PVC reduction >95%). Conclusion In patients with RBBB morphology and/or multiple PVC patterns, CMR imaging before ablation may be helpful due to the increased prevalence of fibrotic lesions with regard to patient stratification and periprocedural management.