Oebel S, et al. -- This study was performed to confirm whether cardiac magnetic resonance (CMR) imaging before ablation in patients with right bundle branch block (RBBB) morphology and/or multiple premature ventricular contraction (PVCs) patterns is helpful in patient stratification and periprocedural management. Researchers concluded that CMR imaging before ablation may be helpful due to the increased prevalence of fibrotic lesions.

Methods:

• Researchers from HELIOS Heart Center at the University of Leipzig in Leipzig, Germany analyzed 101 patients referred for ablation of PVCs.
• The CMR protocol included cine and 3D-delayed enhancement imaging using standard cardiac geometries.

Results:

• On surface ECG, RBBB morphology was reported to be present in 43% of patients.
• Twenty-one patients demonstrated fibrotic substrate on CMR.
• On univariate analysis, both RBBB morphology and presence of multiple PVC morphologies (≥2) significantly predicted the presence of fibrotic substrate, which various baseline characteristics, including left ventricular ejection fraction, 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% of patients.