Feasibility of Cardiac Magnetic Resonance Wideband Protocol in Patients With Implantable Cardioverter Defibrillators and Its Utility for Defining Scar

Amita Singh, Keigo Kawaji, Neha Goyal, Noreen T. Nazir, Andrew Beaser, Virginia O'Keefe-Baker, Karima Addetia, Roderick Tung, Peng Hu, Victor Mor-Avi, Amit R. Patel

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Implantable cardioverter defibrillators (ICDs) have been a relative contraindication to cardiovascular magnetic resonance imaging. Although cardiovascular magnetic resonance provides valuable information regarding scar in patients with ventricular arrhythmias or cardiomyopathy, ICDs in these patients frequently cause artifacts hindering accurate interpretation of both cine and late gadolinium enhancement (LGE) images. We sought to quantify the frequency and severity of artifact on LGE images and assess whether a modified wideband LGE protocol could improve the diagnostic yield of scar identification in agreement with invasive electroanatomic mapping (EAM). Forty-nine patients with ICDs and ventricular tachycardia (VT) or cardiomyopathy underwent CMR (Philips 1.5T), including standard and wideband LGE imaging. A safety algorithm was followed throughout the protocol. Standard and wideband LGE short-axis images were graded using an artifact score on a per-slice basis. LGE on wideband images was compared with EAM in 27 of 49 patients who underwent VT ablation. There were no adverse patient- or device-related events. With standard LGE imaging, 84% of patients demonstrated some degree of hyperenhancement artifact, which persisted in 22% on wideband LGE but with much less extent. Wideband LGE imaging resulted in an increase from 48% to 94% diagnostic-quality slices, with a significant reduction in artifact score, and correlated with EAM in 21 of 27 patients (78%). In conclusion, assessment of standard LGE is markedly limited by artifact in patients with ICD. The use of wideband LGE significantly improves image quality and can accurately localize myocardial scar before VT ablation.

Original languageEnglish (US)
Pages (from-to)1329-1335
Number of pages7
JournalAmerican Journal of Cardiology
Volume123
Issue number8
DOIs
StatePublished - Apr 15 2019
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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