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.
Highlights
Cardiac magnetic resonance (CMR) provides excellent assessment of cardiac morphology and function and enables detailed myocardial tissue characterization with a high degree of precision [1]
Using the late gadolinium enhancement technique for regional myocardial scar detection as well as novel T1 mapping techniques for diffuse fibrosis assessment, CMR is widely regarded as the gold standard for identifying structural arrhythmogenic substrate in patients with ventricular arrhythmias, which is often not detected in conventional investigations [2,3]
We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning for suppressing ventricular ectopy and acquiring high quality images
Summary
Cardiac magnetic resonance (CMR) provides excellent assessment of cardiac morphology and function and enables detailed myocardial tissue characterization with a high degree of precision [1]. When frequent premature ventricular contractions (PVCs) are present during the scan, the quality of the CMR images is severely degraded due to significant R-R interval variations [6]. Most scanners offer arrhythmia sorting capabilities, with a prespecified acquisition window allowing only some R-R variation. This method results in prolonged acquisition and breath-holding times. It frequently fails when ectopic beats are present in the form of bigeminy or trigeminy, making prospective gating with compromised image quality the only viable option. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning for suppressing ventricular ectopy and acquiring high quality images
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