Device artifact reduction for magnetic resonance imaging of patients with implantable cardioverter-defibrillators and ventricular tachycardia: Late gadolinium enhancement correlation with electroanatomic mapping

Abstract

Background Late Gadolinium Enhancement (LGE) MRI of ventricular scar has been shown to be accurate for detection and characterization of arrhythmia substrates. However, the majority of patients referred for ventricular tachycardia (VT) ablation have an implantable cardioverter defibrillator (ICD), which obscures image integrity and the clinical utility of MRI. Objective To develop and validate a wideband LGE MRI technique for device artifact removal. Methods A novel wideband LGE MRI technique was developed to allow for improved scar evaluation on patients with ICDs. The wideband technique and the standard LGE MRI were tested on 18 patients with ICDs. VT ablation was performed in 13 of 18 patients with either endocardial and/or epicardial approach and the correlation between the scar identified on MRI and electroanatomical mapping was analyzed. Results Hyper-intensity artifact was present in 16/18 of patients using standard MRI, which was eliminated using the wideband LGE and allowed for MRI interpretation in 15/16 patients. All patients had ICD lead characteristics confirmed as unchanged post- MRI and had no adverse events. LGE scar was seen in 11/18 patients. Among the 15 patients where wideband LGE allowed visualization of myocardium, 10 had LGE scar and 5 had normal myocardium in the regions with image artifacts when using the standard LGE. The left ventricular scar size measurements using wideband MRI and EAM were correlated with R2=0.83, P=0.00003. Conclusions The wideband LGE-MRI improves the ability to visualize myocardium for clinical interpretation, which correlated well with EAM findings during VT ablation.

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

“…The presence of an implantable cardioverter defibrillator (ICD) is still a contraindication to MRI. However, in the future such patients could benefit from the development of MR-conditional implants under certain conditions [73].…”

Clinical and Electrophysiological Predictors of Recurrent Postinfarction Ventricular Tachicardias After Catheter Ablation

“…Вместе с тем, существуют определенные сложности проведения интервенционного вмеша-тельства, поскольку местоположения циклов ри-ентри и характеристики ЖТ значительно варьируют из-за трехмерной геометрии инфарктных областей. Это ассоциировано с размером, глубиной поражения, трансмуральной дисперсией рефрактерности и гео-метрией миокардиального рубца после острого ИМ (ОИМ) [3,4]. К тому же, проведение радиочастотной аблации (РЧА) ограничено при неустойчивых, гемо-динамически значимых и неиндуцируемых тахикар-диях.…”

Cardiovascular Magnetic Resonance in Patients With Magnetic Resonance–Conditional Cardiac Implantable Electronic Devices

“…Artifactual myocardial hyperintensity on late gadolinium enhancement images may potentially mimic infarct or fibrosis when the resonant frequency offset caused by the metal of the device generator exceeds the bandwidth of the inversion pulse. Rashid et al 12 and Stevens et al 13 showed that by simply increasing the bandwidth of the inversion recovery pulse, the inversion became much more uniform in the face of local field inhomogeneities, and the artifact was reduced. A wideband inversion pulse was also shown to be successful in reducing artifacts in late gadolinium enhancement imaging of patients with ICDs scanned at 3.0T, 14 where the local susceptibility gradients surrounding a metallic implant are twice what they are at 1.5T.…”