A modified wideband inversion pulse late gadolinium enhancement MRI sequence reduces artifacts from implanted cardiac devices, yielding suboptimal diagnostic images in only 7.5% of cases.
Modified inversion pulse LGE CMR sequences can help overcome device-related artifacts to safely image myocardial fibrosis and guide VT ablation in patients with ICDs.
Expanding implantable cardioverter-defibrillator (ICD) indications and significant morbidity and mortality reduction benefits have resulted in a large number of routine ICD implants with appropriate ICD shocks for ventricular arrhythmias. The side-effects and lack of long-term efficacy of antiarrhythmics have made ventricular tachycardia (VT) ablation an increasingly attractive treatment option. Although cardiac magnetic resonance imaging (CMR) is considered the gold standard technique for imaging of myocardial fibrosis to diagnose and guide VT ablation targets in patients with cardiac arrhythmia, safety concerns and significant artifacts from the devices significantly limit the application of CMR. We discuss how to decrease artifact from cardiac devices and the role of a modified inversion pulse late gadolinium enhancement (LGE) CMR sequence as a useful tool in this setting, and we review techniques, safety protocols and limitations from the perspective of our institution’s experience.
Lee et al. (Tue,) conducted a review in Implanted cardiac devices and arrhythmia (n=264). Modified wideband inversion pulse late gadolinium enhancement (LGE) CMR sequence vs. Conventional LGE sequence was evaluated on Suboptimal image quality due to ICD artifact limiting diagnosis. A modified wideband inversion pulse late gadolinium enhancement MRI sequence reduces artifacts from implanted cardiac devices, yielding suboptimal diagnostic images in only 7.5% of cases.
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