Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography

TL;DR

A 13-year-old boy with irregular heartbeats was studied using real-time MRI and ECG to assess heart function during normal and abnormal heart rhythms.

Contribution

The study demonstrates the use of real-time MRI combined with ECG to analyze hemodynamics in severe arrhythmias when conventional methods fail.

Findings

Left ventricular systolic function was stable during sinus beats, with high volumes but normal ejection fraction.

Right ventricular function was reduced during sinus beats and further impaired during premature contractions.

Premature contractions showed lower stroke volume and ejection fraction in both ventricles compared to sinus beats.

Abstract

A 13-year-old asymptomatic boy presented with new-onset extrasystoles. His initial electrocardiogram (ECG) showed an irregular heart rhythm with some sinus beats but also numerous premature atrial contractions with aberrant ventricular conduction. While the initial cardiovascular magnetic resonance (CMR) study could be performed conventionally, more irregular extrasystoles impeded the follow-up study. Therefore, cardiac real-time MRI (RT-MRI) was performed in combination with a simultaneously acquired ECG, which enabled high image quality and the analysis of sinus and arrhythmic beats separately. RT-MRI volumetry of the sinus beat showed a stable systolic function in the left ventricle (LV) [LV ejection fraction of 54.3% and LV stroke volume of 61.1 ml/m2 (90th percentile)] and increased but stable LV volumes [LV end-diastolic volume of 112.6 ml/m2 (>97th percentile) and LV end-systolic volume of 51.1 ml/m2 (>97th percentile)]. In contrast, right ventricular (RV) function was reduced in sinus beats. In the premature contractions, RV and LV end-diastolic volume, stroke volume, and ejection fraction were lower, while the end-systolic volume was higher. In this patient with severe cardiac arrhythmias, conventional CMR could not provide adequate image quality. RT-MRI offered high image quality during free breathing and, in combination with an ECG, it provided a unique opportunity to analyze the hemodynamics of the premature beats and sinus beats as separate entities.

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