Abstract 15965: Device Artifact Reduction in Delayed Enhancement Magnetic Resonance Imaging of Patients With Implantable Defibrillators and Ventricular Tachycardia: Correlation With Electroanatomical Mapping
BACKGROUND: Late Gadolinium Enhancement (LGE) Magnetic Resonance Imaging (MRI) of scar has been shown to be accurate and useful for ablation of Ventricular Tachycardia (VT). However, the majority of patients have an Implantable Cardioverter Defibrillator (ICD), which obscures image integrity and the clinical utility of MRI.
METHODS: LGE-MRI was done on 12 patients with VT for assessment of scar. DHE imaging using standard pulse inversion was performed in all patients resulting in images obscured by artifact. Wide Bandwidth LGE Pulse Sequence (WIBAN) corrects for this, allowing for normal inversion in tissue excited by MR. VT ablation was performed in 9 of 12 patients with endocardial and/or epicardial approach with correlation of electroanatomical maps (EAM).
RESULTS: LGE-MRI with WIBAN was completed in 12 patients. Device artifact over myocardium was seen in 83% (10/12) patients (right sided device without artifact, n=1). Using the WIBAN protocol, the artifact was no longer present and allowed MRI interpretation in 9 of 10 patients. All 12 patients had ICD lead characteristics confirmed as unchanged after the MRI, and there were no MRI related adverse events. The most common location of artifact was the anterior wall of the left ventricle (LV), 6 of 12 patients. LGE scar was seen in 7 of 12 patients. Among the 10 patients where WIBAN allowed visualization myocardium, 3 of 10 had DHE in the same region and 7 of 10 had normal myocardium. Amongst the 9 patients referred for VT ablation, 8 underwent EAM voltage maps, and correlation with MRI for either scar or normal myocardium was seen 6 of 6 patients for the LV, and 0/2 for the right ventricle.
CONCLUSIONS: A novel LGE MRI artifact correction protocol to image ventricular scar is clinically feasible and results in MRI images with an increased yield for clinical interpretation, which correlated well with EAM findings.
- © 2013 by American Heart Association, Inc.