Wideband LGE MRI permits unobstructed viewing of myocardial scarring in a patient with an MR-conditional subcutaneous implantable cardioverter-defibrillator

A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative device for prevention of sudden cardiac death, without any leads within the heart. Patients implanted with any type of ICD may need catheter ablation of ventricular tachycardia (VT) to reduce the overall arrhythmia burden (e.g., recurrent monomorphic VT) and lower the incidence of painful shocks induced by the device. Late gadolinium enhancement (LGE) MRI is a useful pre-test for guiding VT ablation, because it can be used to map myocardial scar and produce better outcomes. Growing evidence suggests that MRI can be performed with manageable risks on patients with a cardiac implantable electronic device (CIED). Nonetheless, the diagnostic yield of cardiac MRI is still low because of severe image artifacts, regardless of MR-conditional or non-MR conditional labeling. Image artifacts in the heart induced by an S-ICD is expected to be larger than the artifacts induced by a transvenous ICD, because the former is twice as large in size and implanted closer to the heart. This is the first reported case of successful wideband LGE MRI in a patient implanted with an MR-conditional S-ICD. A 37-year-old man with ischemic cardiomyopathy was referred for a cardiac MRI at 1.5 T ten months after S-ICD implantation, in order to rule out constrictive pericarditis. Clinical standard LGE MRI produced severe image artifacts, rendering it useless. In contrast, wideband LGE MRI provided unobstructed viewing of myocardial scarring. This case illustrates the usefulness of wideband LGE MRI for assessment of myocardial scarring in a patient with an MR-conditional S-ICD.