Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging

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.

Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias

“…In patients with a high burden of PVCs (bigeminy or trigeminy), we administered procainamide on the scanner table to acquire high quality retrospective cine images, which has been shown to be effective and safe for the suppression of PVCs as previously described [ 12 ]. More specifically, procainamide hydrochloride (Biocoryl ® , vial 1 g/10 mL) was administered on the scanner table at intermittent i.v.…”

The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

“…However, in patients with frequent arrhythmias and grossly irregular rhythm, it is impossible to predict an optimal trigger window, and therefore the rejection of a large amount of data leads to significantly longer breath-hold times [ 91 ]. In this setting, a safe and effective alternative approach to suppress the PVCs and acquire high-quality images is the bolus intravenous administration of an anti-arrhythmic medication, such as procainamide [ 92 ]. In cases with frequent PVCs or AF, prospective triggering may provide diagnostic image quality ( Supplementary Video 2 ).…”

Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

“…In addition to diagnostic purposes, the identification and localization of myocardial fibrosis is also important for proper planning of CA and carries significant prognostic implications as the presence of CMR abnormalities has been correlated with increased risk of malignant arrhythmic events during long-term follow-up [50,54,55]. Nonetheless, CMR carries some limitations in patients with frequent PVCs, including gating difficulties and motion artifacts due to the irregular rhythm [56,57]. Furthermore, identification of fibro-fatty replacement of the right ventricular wall may be problematic due to its thin structure [43].…”