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

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...

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Main Authors: Lena Maria Röwer, Miriam Nathalie Tappel, Mohamed Ali Goundi, Anja Müller-Lutz, Mohamed Abd El Rahman, Jana Rieke, Gerrit Steinhagen, Mathias Emmel, Dirk Klee, Frank Pillekamp
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Cardiovascular Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2025.1596440/full
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author Lena Maria Röwer
Miriam Nathalie Tappel
Mohamed Ali Goundi
Anja Müller-Lutz
Mohamed Abd El Rahman
Jana Rieke
Gerrit Steinhagen
Mathias Emmel
Dirk Klee
Frank Pillekamp
author_facet Lena Maria Röwer
Miriam Nathalie Tappel
Mohamed Ali Goundi
Anja Müller-Lutz
Mohamed Abd El Rahman
Jana Rieke
Gerrit Steinhagen
Mathias Emmel
Dirk Klee
Frank Pillekamp
author_sort Lena Maria Röwer
collection DOAJ
description 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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spelling doaj-art-7d47adeceedb468f8b56ccdf690860822025-08-20T02:36:53ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-06-011210.3389/fcvm.2025.15964401596440Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiographyLena Maria Röwer0Miriam Nathalie Tappel1Mohamed Ali Goundi2Anja Müller-Lutz3Mohamed Abd El Rahman4Jana Rieke5Gerrit Steinhagen6Mathias Emmel7Dirk Klee8Frank Pillekamp9Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyIndependent Practitioner, Hilden, GermanyDepartment of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Cologne, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyA 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.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1596440/fullcardiac arrhythmiasatrial premature complexescardiovascular magnetic resonance imagingreal-time MRIpediatrics
spellingShingle Lena Maria Röwer
Miriam Nathalie Tappel
Mohamed Ali Goundi
Anja Müller-Lutz
Mohamed Abd El Rahman
Jana Rieke
Gerrit Steinhagen
Mathias Emmel
Dirk Klee
Frank Pillekamp
Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
Frontiers in Cardiovascular Medicine
cardiac arrhythmias
atrial premature complexes
cardiovascular magnetic resonance imaging
real-time MRI
pediatrics
title Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
title_full Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
title_fullStr Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
title_full_unstemmed Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
title_short Case Report: Hemodynamic consequences of severe supraventricular arrhythmia assessed by real-time magnetic resonance imaging in combination with electrocardiography
title_sort case report hemodynamic consequences of severe supraventricular arrhythmia assessed by real time magnetic resonance imaging in combination with electrocardiography
topic cardiac arrhythmias
atrial premature complexes
cardiovascular magnetic resonance imaging
real-time MRI
pediatrics
url https://www.frontiersin.org/articles/10.3389/fcvm.2025.1596440/full
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