Arrhythmia substrate identification using wideband motion-corrected late gadolinium enhancement magnetic resonance imaging in a swine model of myocardial infarction with taped implantable cardioverter-defibrillators.

Background: Sudden cardiac death is a leading worldwide cause of cardiac mortality and is largely related to ventricular tachycardia (VT) in patients with known myocardial scarring. In these patients, implantable cardioverter-defibrillator (ICD) therapy reduces arrhythmia-related mortality. However, curative procedures such as catheter ablation are used to homogenize regions of scar and remove structural re-entry circuits that cause VT. Objective: In this paper, we conduct a preliminary experiment comparing 2-dimensional (2D) late gadolinium enhancement (LGE) and 3-dimensional (3D) LGE without an ICD with wideband motion-corrected (WB-MOCO) LGE with an ICD in a cohort of infarcted Yorkshire swine. Methods: Animals were imaged after infarct with conventional 2D and 3D LGE without an ICD present and 2D WB-MOCO LGE with an ICD present. Images were analyzed to determine heterogeneous tissue corridor (HTC) count and location, which were compared with circuit exit locations determined using a 12-lead electrocardiogram. Results: We found a statistically significant increase in HTC count with WB-MOCO LGE, but no significant differences in the number of true-positive or false-positive HTCs per subject. Conclusion: WB-MOCO LGE has reduced specificity to physiologically relevant HTCs than conventional 2D or 3D LGE.