Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias

Daniele Muser, Pasquale Santangeli, Joseph Selvanayagam, Gaetano Nucifora

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to "idiopathic". In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently "idiopathic" VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.

LanguageEnglish
Pages12-23
Number of pages12
JournalCurrent cardiology reviews
Volume15
Issue number1
DOIs
Publication statusPublished - 2019

Keywords

  • Cardiac magnetic resonance
  • idiopathic
  • late gadolinium enhancement
  • structural heart disease
  • tissue characterization
  • ventricular arrhythmias.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Muser, Daniele ; Santangeli, Pasquale ; Selvanayagam, Joseph ; Nucifora, Gaetano. / Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias. In: Current cardiology reviews. 2019 ; Vol. 15, No. 1. pp. 12-23.
@article{7692ffce010c49c5b31c3a71b3b6d5ac,
title = "Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias",
abstract = "Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50{\%} of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to {"}idiopathic{"}. In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently {"}idiopathic{"} VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.",
keywords = "Cardiac magnetic resonance, idiopathic, late gadolinium enhancement, structural heart disease, tissue characterization, ventricular arrhythmias.",
author = "Daniele Muser and Pasquale Santangeli and Joseph Selvanayagam and Gaetano Nucifora",
year = "2019",
doi = "10.2174/1573403X14666180925095923",
language = "English",
volume = "15",
pages = "12--23",
journal = "Current cardiology reviews",
issn = "1573-403X",
publisher = "Bentham Science Publishers B.V.",
number = "1",

}

Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias. / Muser, Daniele; Santangeli, Pasquale; Selvanayagam, Joseph; Nucifora, Gaetano.

In: Current cardiology reviews, Vol. 15, No. 1, 2019, p. 12-23.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias

AU - Muser, Daniele

AU - Santangeli, Pasquale

AU - Selvanayagam, Joseph

AU - Nucifora, Gaetano

PY - 2019

Y1 - 2019

N2 - Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to "idiopathic". In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently "idiopathic" VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.

AB - Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to "idiopathic". In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently "idiopathic" VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.

KW - Cardiac magnetic resonance

KW - idiopathic

KW - late gadolinium enhancement

KW - structural heart disease

KW - tissue characterization

KW - ventricular arrhythmias.

UR - http://www.scopus.com/inward/record.url?scp=85058881198&partnerID=8YFLogxK

U2 - 10.2174/1573403X14666180925095923

DO - 10.2174/1573403X14666180925095923

M3 - Article

VL - 15

SP - 12

EP - 23

JO - Current cardiology reviews

T2 - Current cardiology reviews

JF - Current cardiology reviews

SN - 1573-403X

IS - 1

ER -