Fig. 3.

Typical appearances of CIED-related artefacts on CMR images. All images are in short-axis plane. The RV lead-induced artefacts are indicated with an asterisk (A–L). Banding artefacts seen in bSSFP sequences are presented with arrowheads (A, E, H, J). The thick arrow shows hyperintensity artefact, typically seen in SPGR sequences (K). The thin arrow indicates the LV coronary sinus lead-induced artefact (G, I). Generator-induced banding artefact interfering with the myocardium is seen in bSSFP sequences, typically in patients with left-sided generator (A, E, H, J). In SPGR sequences, a large signal-void area induced by the generator is a typical artefact (D, F). Arm-raised scanning position can shift the generator-induced artefacts away from the myocardium (B, F). However, severe artefacts may be present despite the arm-raised scanning position (E, H, J). In patients with left-sided CRT device, LV lead-induced artefact can be obscured by generator-induced artefacts (H). Hyperintensity artefact in LGE imaging could be misinterpreted as positive LGE (K). In image K, the LV anterior wall is affected by hyperintensity artefact, but the subendocardial LGE finding in the LV inferior wall related to ischemic scar is clearly visible. In patients with right-sided generator, the image quality is usually diagnostic (C, I, L). Image L shows patchy intramyocardial and subepicardial LGE in the LV wall extending to the RV wall, related to cardiac sarcoidosis. bSSFP = balanced steady-state free precession; CIED = cardiac implantable electronic device; CMR = cardiac magnetic resonance imaging; CRT-D = cardiac resynchronization therapy; CRT-D = cardiac resynchronization therapy defibrillator; ICD = implantable cardioverter-defibrillator; LGE = late-gadolinium enhancement; LV = left ventricular; PM = pacemaker; PSIR = pPhase-sensitive inversion recovery; RV = right ventricular; SPGR = spoiled gradient echo