Quality assessment of cardiac magnetic resonance myocardial scar imaging prior to ventricular arrhythmia ablation

Rushil Shah, Apurva Sharma, Fabrizio Assis, Henrique Doria De Vasconcellos, Navya Alugubelli, Pallavi Pandey, Tauseef Akhtar, Alessio Gasperetti, Shijie Zhou, Henry Halperin, Stefan L. Zimmerman, Harikrishna Tandri, Aravindan Kolandaivelu

Research output: Contribution to journalArticlepeer-review


High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.

Original languageEnglish (US)
Pages (from-to)411-421
Number of pages11
JournalInternational Journal of Cardiovascular Imaging
Issue number2
StatePublished - Feb 2023


  • Arrythmia
  • Cardiac magnetic resonance imaging
  • Catheter ablation
  • Implantable cardioverter defibrillator (ICD)
  • Late gadolinium enhancement (LGE)
  • Motion artifact
  • Ventricular tachycardia (VT)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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