Objectives Echocardiography is routinely recommended to evaluate structural abnormalities in patients with ventricular tachycardia. However, the performance of cardiac magnetic resonance imaging (MRI) in the evaluation of patients with hemodynamic stable ventricular arrhythmia (VA) has not been verified. In the present study, we investigated the diagnostic yield of cardiac MRI in identifying potential cardiac abnormalities in patients referred for ablation of VA.
Methods Cardiac MRI (CMR) was performed in 78 consecutive patients (average age 43.6 ± 16.5 years) with premature ventricular contraction or hemodynamic stable paroxysmal ventricular tachycardia referred for transcatheter ablation. Patients with prior known structural heart disease were excluded. All the patients received standard clinical non-CMR evaluation before CMR examination.
Results Cardiac MRI findings were abnormal in 48 patients (61.5%), including late gadolinium enhancement (LGE) in 23.1%. The diagnostic yield of cardiac MRI was significantly greater than that of routine non-CMR modalities, with which findings were positive in 28.2% of patients. Cardiac MRI detected 31 cases (55.4%) of abnormalities in 56 patients in whom echocardiography was negative. LGE patterns in patients with VA were variable and LGE in myocardium was associated with worse right and left ventricular function.
Conclusions Cardiac MRI was a more effective tool than routine echocardiography in identifying potential structural abnormalities in patients with stable VA before ablation. Comprehensive cardiac MRI should be considered a routine screening examination before VA ablation even in patients without prior known structural heart disease.