title: 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) magnetic resonance imaging (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
  The purpose of this study was 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 electroanatomic mapping (EAM) was analyzed.
  
  
  RESULTS
  Hyperintensity artifact was present in 16 of 18 of patients using standard MRI, which was eliminated using the wideband LGE and allowed for MRI interpretation in 15 of 16 patients. All patients had ICD lead characteristics confirmed as unchanged post-MRI and had no adverse events. LGE scar was seen in 11 of 18 patients. Among the 15 patients in whom 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 R(2) = 0.83 and P = .00003.
  
  
  CONCLUSIONS
  Wideband LGE MRI improves the ability to visualize myocardium for clinical interpretation, which correlated well with EAM findings during VT ablation.
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Stevens
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Shams
authors.initials: S
authors.lastname: Rashid
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Jean
authors.initials: J
authors.lastname: Gima
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Shelly
authors.initials: S
authors.lastname: Cote
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Pavez
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ennis
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: J Paul
authors.initials: JP
authors.lastname: Finn
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Noel
authors.initials: N
authors.lastname: Boyle
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California. Electronic address: penghu@mednet.ucla.edu.
authors.forename: Peng
authors.initials: P
authors.lastname: Hu
mesh_terms: D016477:Artifacts; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D017180:Tachycardia, Ventricular / Q000473:pathology* / Q000601:surgery
chemical_list: D005682:Gadolinium
keywords: Ablation; Arrhythmia; Catheter ablation; Clinical electrophysiology; Delayed enhancement; EAM; Electroanatomic mapping; ICD; Image artifact; Implantable cardioverter-defibrillator; LGE; LV; Late gadolinium enhancement; MRI; Magnetic resonance imaging; Myocardial scar; VT; Ventricular tachycardia; electroanatomic mapping; implantable cardioverter-defibrillator; late gadolinium enhancement; left ventricle; magnetic resonance imaging; ventricular tachycardia