Daniel K.H. Thomas MD, Presenter: Nothing to Disclose

Claas Philip Naehle MD, Abstract Co-Author: Research Grant, Medtronic, Inc

Daruis Dabir, Abstract Co-Author: Nothing to Disclose

Hans H. Schild MD, Abstract Co-Author: Nothing to Disclose

Jutta Weisser-Thomas, Abstract Co-Author: Nothing to Disclose

MRI identifies the anatomic substrate of VA in cardiomyopathies and coronary heart disease, however, little is known about the clinical value of MRI in patients with VA without previously known cardiac conditions disease. Thus the purpose of this study was, to investigate the value of MRI for assessing the incidence of underlying heart disease and arrhythmogenic substrate in patients with high-grade ventricular arrhythmia (VA).  

76 patients with high-grade VA, without known cardiac condition, were studied with MRI, echocardiography and ECGs. 49 patients underwent additional electrophysiologic testing (EPS). MRI findings were correlated with ECG and EPS. A structural abnormality or scar detected by MRI matching the VA origin as defined by ECG and/or EPS, or a cardiac condition detected by MRI, known to cause associated arrhythmia were defined as morphological VA substrate. MRI findings were defined as clinically relevant, if resulting in a new diagnosis, change of treatment, or additional diagnostic procedure.

44/76 (58%) patients demonstrated pathological MRI findings. In 23/76 patients the pathological finding was only detected by MRI, and not by echocardiography or ECG. Based on MRI findings a diagnosis of heart disease was established in 20/76 patients, in 16/20 by MRI only. All MRI based diagnoses were classified as morphological substrates. In seven patients the location of the MRI finding (myocardial scar) directly matched the VA origin as defined by ECG or EPS. MRI findigs resulted in a change of treatment in 16 patients, a change of treatment plus additional diagnostic procedures in 5 patients, and further diagnostic procedures in 3 patients.

This is the first study demonstrating the value of MRI for detection of the morphological substrate and/or underlying cardiac disorder in patients with high-grade VA, without previously known cardiac disease. The high incidence of clinically relevant MRI findings supports the use of MRI to screen these patients for underlying heart disease.

In a high percentage of patients with high grade ventricular arrhythmias an underlying heart disease can be detected by MRI, which may be missed by other diagnostic procedures.

Thomas, D, Naehle, C, Dabir, D, Schild, H, Weisser-Thomas, J, Pathological CMR Findings and Their Clinical Value in Patients with High Grade Ventricular Arrhythmias Without Previously Known Cardiac Disease.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12037292.html