JCMR 2020; 22:35. Clinical experience regarding safety and diagnostic value of cardiovascular magnetic resonance in patients with a subcutaneous implanted cardioverter/defibrillator (S-ICD) at 1.5 T (-s12968-020-00626-y

s12968-020-00626-y

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This study evaluated the safety, image quality, and clinical usefulness of 1.5T cardiovascular magnetic resonance (CMR) in 23 patients with a subcutaneous implantable cardioverter/defibrillator (S-ICD). All scans were completed successfully without serious complications, device resets, lead problems, thermal symptoms, or hemodynamic instability. The main technical issue was permanent loss of the S-ICD beeper/alarm volume in 52% of patients after exposure to the magnetic field, although device function remained intact.<br /><br />Image quality was sometimes limited by artifacts from the S-ICD generator, especially in the left ventricular anterior, lateral, and inferior wall segments. Standard balanced steady-state free precession (bSSFP) cine images were often affected, but switching to spoiled gradient-echo cine sequences improved assessment in most cases, allowing good or limited-artifact images in 74% of patients. Conventional late gadolinium enhancement (LGE) imaging was also prone to artifacts, but wide-band LGE helped reduce them in 65% of cases. T2-weighted edema imaging and aortic flow measurements were generally feasible, while resting myocardial perfusion imaging was the most problematic, with artifacts preventing meaningful interpretation in at least half of patients. Three-dimensional aortic angiography was assessable in all cases.<br /><br />CMR provided clinically useful information in 74% of patients, helping establish or revise diagnoses such as non-ischemic cardiomyopathy, myocarditis, inflammatory cardiomyopathy, and scar-related disease. It also supported decisions about ablation, biopsy, medication changes, follow-up, and genetic testing.<br /><br />Overall, the study concludes that 1.5T CMR can be performed safely in patients with S-ICDs and should not be avoided out of safety concerns alone. Although artifacts can be challenging, especially for perfusion imaging, optimized techniques such as spoiled GRE cine and wide-band LGE can substantially improve diagnostic value.

Keywords

cardiovascular magnetic resonance

S-ICD

1.5T MRI

image artifacts

spoiled gradient-echo

wide-band LGE

myocardial perfusion

safety

cardiomyopathy

clinical usefulness