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Wicks EC, Menezes LJ, Elliott PM. Improving the diagnostic accuracy for detecting cardiac sarcoidosis. Expert Rev Cardiovasc Ther 2015; 13:223-36. [DOI: 10.1586/14779072.2015.1001367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW To assess the current knowledge about the potential hazard from MRI in patients with devices such as pacemakers and implantable cardioverter defibrillators (ICDs). RECENT FINDINGS Most data concern 'MRI unsafe' devices, with only a few studies on 'MRI conditional' devices. No 'MRI safe' cardiac devices are currently available. Studies on 'MRI unsafe' devices tend to be small scale and reflect the experience of individual centres; few provide long-term follow-up data. Many newer devices are approved as 'MRI conditional' based on technical simulations or postmarket surveillance studies. With adequate measures taken before performing an MRI scan, reported complication rates are generally low, but there is a nonnegligible residual risk for power-on reset and lead heating. The presence of abandoned, older leads may affect the propensity for lead heating during MRI with newer devices, including those designated 'MRI conditional'. Very little research has been carried out on the hazard from MRI scans in patients with ICDs, but registry data indicate more events with ICDs than with pacemakers. SUMMARY The limited available data indicate a manageable but not negligible MRI-associated hazard in patients with implantable cardiac devices. Further controlled studies and large, independent registries, particularly in Europe, are needed to provide important safety information.
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Tao Q, Piers SRD, Lamb HJ, Zeppenfeld K, van der Geest RJ. Preprocedural magnetic resonance imaging for image-guided catheter ablation of scar-related ventricular tachycardia. Int J Cardiovasc Imaging 2014; 31:369-77. [PMID: 25341408 DOI: 10.1007/s10554-014-0558-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Abstract
To present and validate a highly automated MRI analysis workflow for image-guided catheter ablation of scar-related ventricular tachycardia (VT) ablation procedures. A cohort of 15 post-infarction patients underwent MRI prior to VT ablation. The MRI study included a black-blood turbo spin echo sequence for visualizing the aortic root and ostium of the left main (LM) coronary artery, and a 3D late gadolinium enhanced sequence for visualizing the LV anatomy and myocardial scar substrate. Semi-automated segmentation of the LV, aortic root and ostium of LM was performed, followed by fully automated segmentation of myocardial scar. All segmented structures were aligned using an automated image registration algorithm to remove inter-scan displacement. MRI was integrated at the beginning of the procedure after mapping a single LM point. The integration performance was compared to that of the traditional iterative closest point (ICP) method. The proposed method required a single LM mapping point only, compared to 255 ± 43 points with the ICP method. The single-point method achieved a mean point-to-surface distance of 4.9 ± 1.5 mm on the LV surface and 5.1 ± 1.7 mm on the aorta surface (ICP: 3.7 ± 0.8 and 9.2 ± 7.2 mm, P < 0.05). The Cohen's kappa coefficient between the MRI-defined and EAM-defined scar was 0.36 ± 0.16 for the presented method, significantly higher than that of ICP method (0.23 ± 0.21, P = 0.03), indicating more accurate scar substrate localization during integration. This study demonstrated the feasibility of preprocedural MRI integration into the VT ablation procedure, with highly automated image analysis workflow and minimal mapping effort.
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Affiliation(s)
- Qian Tao
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands,
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Affiliation(s)
- Atul R Chugh
- From the Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY (A.R.C.); and Department of Medicine, Division of Cardiovascular Medicine, John Hopkins University, Baltimore, MD (J.A.C.L.)
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Qian D, El-Sharkawy AMM, Bottomley PA, Edelstein WA. An RF dosimeter for independent SAR measurement in MRI scanners. Med Phys 2014; 40:122303. [PMID: 24320534 DOI: 10.1118/1.4829527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The monitoring and management of radio frequency (RF) exposure is critical for ensuring magnetic resonance imaging (MRI) safety. Commercial MRI scanners can overestimate specific absorption rates (SAR) and improperly restrict clinical MRI scans or the application of new MRI sequences, while underestimation of SAR can lead to tissue heating and thermal injury. Accurate scanner-independent RF dosimetry is essential for measuring actual exposure when SAR is critical for ensuring regulatory compliance and MRI safety, for establishing RF exposure while evaluating interventional leads and devices, and for routine MRI quality assessment by medical physicists. However, at present there are no scanner-independent SAR dosimeters. METHODS An SAR dosimeter with an RF transducer comprises two orthogonal, rectangular copper loops and a spherical MRI phantom. The transducer is placed in the magnet bore and calibrated to approximate the resistive loading of the scanner's whole-body birdcage RF coil for human subjects in Philips, GE and Siemens 3 tesla (3T) MRI scanners. The transducer loop reactances are adjusted to minimize interference with the transmit RF field (B1) at the MRI frequency. Power from the RF transducer is sampled with a high dynamic range power monitor and recorded on a computer. The deposited power is calibrated and tested on eight different MRI scanners. Whole-body absorbed power vs weight and body mass index (BMI) is measured directly on 26 subjects. RESULTS A single linear calibration curve sufficed for RF dosimetry at 127.8 MHz on three different Philips and three GE 3T MRI scanners. An RF dosimeter operating at 123.2 MHz on two Siemens 3T scanners required a separate transducer and a slightly different calibration curve. Measurement accuracy was ∼3%. With the torso landmarked at the xiphoid, human adult whole-body absorbed power varied approximately linearly with patient weight and BMI. This indicates that whole-body torso SAR is on average independent of the imaging subject, albeit with fluctuations. CONCLUSIONS Our 3T RF dosimeter and transducers accurately measure RF exposure in body-equivalent loads and provide scanner-independent assessments of whole-body RF power deposition for establishing safety compliance useful for MRI sequence and device testing.
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Affiliation(s)
- Di Qian
- Division of MR Research, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287 and Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218
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Kaasalainen T, Pakarinen S, Kivistö S, Holmström M, Hänninen H, Peltonen J, Lauerma K, Sipilä O. MRI with cardiac pacing devices – Safety in clinical practice. Eur J Radiol 2014; 83:1387-95. [DOI: 10.1016/j.ejrad.2014.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/08/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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Rapsang AG, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations. Braz J Anesthesiol 2014; 64:205-14. [PMID: 24907883 DOI: 10.1016/j.bjane.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/28/2022] Open
Abstract
A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.
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Affiliation(s)
- Amy G Rapsang
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
| | - Prithwis Bhattacharyya
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Muehling OM, Wakili R, Greif M, von Ziegler F, Morhard D, Brueckmann H, Becker A. Immediate and 12 months follow up of function and lead integrity after cranial MRI in 356 patients with conventional cardiac pacemakers. J Cardiovasc Magn Reson 2014; 16:39. [PMID: 24903354 PMCID: PMC4053551 DOI: 10.1186/1532-429x-16-39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 05/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional cardiac pacemakers are still often regarded as a contraindication to magnetic resonance imaging (MRI). We conducted this study to support the hypothesis that it is safe to scan patients with cardiac pacemakers in a 1.5 Tesla MRI, if close supervision and monitoring as well as adequate pre- and postscan programming is provided. METHODS We followed up 356 patients (age 61.3 ± 9.1 yrs., 229 men) with single (n = 132) or dual chamber (n = 224) cardiac pacemakers and urgent indication for a cranial MRI for 12 months. The scans were performed at 1.5T. During the scan patients were monitored with a 3-lead ECG and pulse oximetry. Prior to the scan pacemakers were programmed according to our own protocol. RESULTS All 356 scans were completed without complications. No arrhythmias were induced, programmed parameters remained unchanged. No pacemaker dysfunction was identified. Follow-up examinations were performed immediately, 2 weeks, 2, 6, and 12 months after the scan. There was no significant change of pacing capture threshold (ventricular 0.9 ± 0.4 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms) immediately (ventricular 1.0 ± 0.3 V@0.4 ms, atrial 0.9 ± 0.4 V@0.4 ms) or at 12 months follow-up examinations (ventricular 0.9 ± 0.2 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms). There was no significant change in sensing threshold (8.0 ± 4.0 mV vs. 8.1 ± 4.2 mV ventricular lead, 2.0 ± 0.9 mV vs. 2.1 ± 1.0 mV atrial lead) or lead impedance (ventricular 584 ± 179 Ω vs. 578 ± 188 Ω, atrial 534 ± 176 Ω vs. 532 ± 169 Ω) after 12 months. CONCLUSIONS This supports the evidence that patients with conventional pacemakers can safely undergo cranial MRI in a 1.5T system with suitable preparation, supervision and precautions. Long term follow-up did not reveal significant changes in pacing capture nor sensing threshold.
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Affiliation(s)
- Olaf M Muehling
- Cardiology Clinic Harlaching, University of Munich, Munich, Germany
| | - Reza Wakili
- Department of Medicine, University of Munich, Munich, Germany
| | - Martin Greif
- Department of Medicine, University of Munich, Munich, Germany
| | | | - Dominik Morhard
- Department of Neuroradiology, University of Munich, Munich, Germany
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Ferreira AM, Costa F, Tralhão A, Marques H, Cardim N, Adragão P. MRI-conditional pacemakers: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:115-24. [PMID: 24851058 PMCID: PMC4019608 DOI: 10.2147/mder.s44063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Use of both magnetic resonance imaging (MRI) and pacing devices has undergone remarkable growth in recent years, and it is estimated that the majority of patients with pacemakers will need an MRI during their lifetime. These investigations will generally be denied due to the potentially dangerous interactions between cardiac devices and the magnetic fields and radio frequency energy used in MRI. Despite the increasing reports of uneventful scanning in selected patients with conventional pacemakers under close surveillance, MRI is still contraindicated in those circumstances and cannot be considered a routine procedure. These limitations prompted a series of modifications in generator and lead engineering, designed to minimize interactions that could compromise device function and patient safety. The resulting MRI-conditional pacemakers were first introduced in 2008 and the clinical experience gathered so far supports their safety in the MRI environment if certain conditions are fulfilled. With this technology, new questions and controversies arise regarding patient selection, clinical impact, and cost-effectiveness. In this review, we discuss the potential risks of MRI in patients with electronic cardiac devices and present updated information regarding the features of MRI-conditional pacemakers and the clinical experience with currently available models. Finally, we provide some guidance on how to scan patients who have these devices and discuss future directions in the field.
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Affiliation(s)
- António M Ferreira
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Francisco Costa
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - António Tralhão
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Hugo Marques
- Radiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Pedro Adragão
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
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110
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Rapsang AG, Bhattacharyya P. Marcapassos e cardioversores desfibriladores implantáveis – considerações gerais e anestésicas. Braz J Anesthesiol 2014; 64:205-14. [DOI: 10.1016/j.bjan.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022] Open
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Abstract
MRI has become an invaluable tool in the evaluation of soft tissue and bony abnormalities. The presence of a cardiac implantable electrical device (CIED) may complicate matters, however, because these devices are considered a contraindication to MRI scanning. When MRI is performed in patients with a CIED, risks include reed switch activation in older devices, lead heating, system malfunction, and significant radiofrequency noise resulting in inappropriate inhibition of demand pacing, tachycardia therapies, or programming changes. This report reviews indications and risk-benefit evaluation of MRI in patients with CIED and provides a clinical algorithm for performing MRI in patients with implanted devices.
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112
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Stevens SM, Tung R, Rashid S, Gima J, Cote S, Pavez G, Khan S, Ennis DB, Finn JP, Boyle N, Shivkumar K, Hu P. Device artifact reduction for magnetic resonance imaging of patients with implantable cardioverter-defibrillators and ventricular tachycardia: late gadolinium enhancement correlation with electroanatomic mapping. Heart Rhythm 2014; 11:289-98. [PMID: 24140812 PMCID: PMC3946910 DOI: 10.1016/j.hrthm.2013.10.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) of ventricular scar has been shown to be accurate for detection and characterization of arrhythmia substrates. However, the majority of patients referred for ventricular tachycardia (VT) ablation have an implantable cardioverter-defibrillator (ICD), which obscures image integrity and the clinical utility of MRI. OBJECTIVE The purpose of this study was to develop and validate a wideband LGE MRI technique for device artifact removal. METHODS A novel wideband LGE MRI technique was developed to allow for improved scar evaluation on patients with ICDs. The wideband technique and the standard LGE MRI were tested on 18 patients with ICDs. VT ablation was performed in 13 of 18 patients with either endocardial and/or epicardial approach and the correlation between the scar identified on MRI and electroanatomic mapping (EAM) was analyzed. RESULTS Hyperintensity artifact was present in 16 of 18 of patients using standard MRI, which was eliminated using the wideband LGE and allowed for MRI interpretation in 15 of 16 patients. All patients had ICD lead characteristics confirmed as unchanged post-MRI and had no adverse events. LGE scar was seen in 11 of 18 patients. Among the 15 patients in whom wideband LGE allowed visualization of myocardium, 10 had LGE scar and 5 had normal myocardium in the regions with image artifacts when using the standard LGE. The left ventricular scar size measurements using wideband MRI and EAM were correlated with R(2) = 0.83 and P = .00003. CONCLUSION Wideband LGE MRI improves the ability to visualize myocardium for clinical interpretation, which correlated well with EAM findings during VT ablation.
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Affiliation(s)
- Steven M Stevens
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Roderick Tung
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shams Rashid
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jean Gima
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shelly Cote
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Geraldine Pavez
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Daniel B Ennis
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Peng Hu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California.
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Cronin EM, Mahon N, Wilkoff BL. MRI in patients with cardiac implantable electronic devices. Expert Rev Med Devices 2014; 9:139-46. [DOI: 10.1586/erd.11.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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115
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ROGUIN ARIEL. Early MRI Scanning of Device Patients-Not So Fast. Pacing Clin Electrophysiol 2013; 36:1447-8. [DOI: 10.1111/pace.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ARIEL ROGUIN
- From the Department of Cardiology; Rambam Medical Center; Ruth and Bruce Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
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116
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Safe magnetic resonance imaging scanning of patients with cardiac rhythm devices: A role for computer modeling. Heart Rhythm 2013; 10:1815-21. [DOI: 10.1016/j.hrthm.2013.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 11/21/2022]
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117
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Rashid S, Rapacchi S, Vaseghi M, Tung R, Shivkumar K, Finn JP, Hu P. Improved late gadolinium enhancement MR imaging for patients with implanted cardiac devices. Radiology 2013; 270:269-74. [PMID: 24086074 DOI: 10.1148/radiol.13130942] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To propose and test a modified wideband late gadolinium enhancement (LGE) magnetic resonance (MR) imaging technique to overcome hyperintensity image artifacts caused by implanted cardiac devices. MATERIALS AND METHODS Written informed consent was obtained from all participants, and the HIPAA-compliant study protocol was approved by the institutional review board. Studies in phantoms and in a healthy volunteer were performed to test the hypothesis that the hyperintensity artifacts that are typically observed on LGE images in patients with implanted cardiac devices are caused by insufficient inversion of the affected myocardial signal. The conventional LGE MR imaging pulse sequence was modified by replacing the nonselective inversion pulse with a wideband inversion pulse. The modified LGE sequence, along with the conventional LGE sequence, was evaluated in 12 patients with implantable cardioverter defibrillators (ICDs) who were referred for cardiac MR imaging. RESULTS The ICD causes 2-6 kHz in frequency shift at locations 5-10 cm away from the device. This off-resonance falls outside the typical spectral bandwidth of the nonselective inversion pulse used in conventional LGE, which results in the hyperintensity artifact. In 10 of the 12 patients, the conventional LGE technique produced severe, uninterpretable hyperintensity artifacts in the anterior and lateral portions of the left ventricular wall. These artifacts were eliminated with use of the wideband LGE sequence, thereby enabling confident evaluation of myocardial viability. CONCLUSION The modified wideband LGE MR imaging technique eliminates the hyperintensity artifacts seen in patients with cardiac devices. The technique may enable LGE MR imaging in patients with cardiac devices, in whom LGE MR imaging otherwise could not be used for diagnosis.
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Affiliation(s)
- Shams Rashid
- From the Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles (S. Rashid, S. Rapacchi, K.S., J.P.F., P.H.); UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, Calif (M.V., R.T., K.S., P.H.); and Biomedical Physics Inter-Departmental Graduate Program, University of California-Los Angeles, Los Angeles, Calif (J.P.F., P.H.)
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Vieira M, Lazoura O, Nicol E, Rubens M, Padley S. MRI in patients with cardiovascular implantable electronic devices. Clin Radiol 2013; 68:928-34. [DOI: 10.1016/j.crad.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 02/20/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Santini L, Forleo GB, Santini M. Implantable devices in the electromagnetic environment. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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120
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Martinelli M. Magnetic resonance imaging and cardiac implantable electronic devices: Safety barrier overtaken—Is the image quality the current target? Heart Rhythm 2013; 10:873-4. [DOI: 10.1016/j.hrthm.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Indexed: 11/16/2022]
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121
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Nazarian S, Beinart R, Halperin HR. Magnetic Resonance Imaging and Implantable Devices. Circ Arrhythm Electrophysiol 2013; 6:419-28. [DOI: 10.1161/circep.113.000116] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saman Nazarian
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Beinart
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Henry R. Halperin
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Calvi V, Gargaro A. Evia HF (-T): the world’s first magnetic resonance approved pace-maker for resynchronization therapy. Interv Cardiol 2013. [DOI: 10.2217/ica.13.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Russo RJ. Determining the risks of clinically indicated nonthoracic magnetic resonance imaging at 1.5 T for patients with pacemakers and implantable cardioverter-defibrillators: rationale and design of the MagnaSafe Registry. Am Heart J 2013; 165:266-72. [PMID: 23453091 DOI: 10.1016/j.ahj.2012.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 12/17/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND Until recently, the presence of a permanent pacemaker or an implantable cardioverter-defibrillator has been a relative contraindication for the performance of magnetic resonance imaging (MRI). A number of small studies have shown that MRI can be performed with minimal risk when patients are properly monitored and device programming is modified appropriately for the procedure. However, the risk of performing MRI for patients with implanted cardiac devices has not been sufficiently evaluated to advocate routine clinical use. The aim of the present protocol is to prospectively determine the rate of adverse clinical events and device parameter changes in patients with implanted non-MRI-conditional cardiac devices undergoing clinically indicated nonthoracic MRI at 1.5 T. METHODS The MagnaSafe Registry is a multicenter, prospective cohort study of up to 1500 MRI examinations in patients with pacemakers or implantable cardioverter-defibrillators implanted after 2001 who undergo clinically indicated nonthoracic MRI following a specific protocol to ensure that preventable potential adverse events are mitigated. Adverse events and changes in device parameter measurements that may be associated with the imaging procedure will be documented. RESULTS Through August 2012, 701 MRI studies have been performed, representing 47% of the total target enrollment. CONCLUSIONS The results of this registry will provide additional documentation of the risk of MRI and will further validate a clinical protocol for screening and the performance of clinically indicated MRI for patients with implanted cardiac devices.
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Siewert B, Brook OR, Mullins MM, Eisenberg RL, Kruskal JB. Practice Policy and Quality Initiatives: Strategies for Optimizing Staff Safety in a Radiology Department. Radiographics 2013; 33:245-61. [DOI: 10.1148/rg.331125174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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SANTINI LUCA, FORLEO GIOVANNIB, SANTINI MASSIMO. Evaluating MRI-Compatible Pacemakers: Patient Data Now Paves the Way to Widespread Clinical Application? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:270-8. [DOI: 10.1111/pace.12061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 09/26/2012] [Accepted: 10/15/2012] [Indexed: 12/20/2022]
Affiliation(s)
- LUCA SANTINI
- Department of Internal Medicine; Division of Cardiology, Policlinico Tor Vergata; Rome; Italy
| | - GIOVANNI B. FORLEO
- Department of Internal Medicine; Division of Cardiology, Policlinico Tor Vergata; Rome; Italy
| | - MASSIMO SANTINI
- Cardiovascular Department; Division of Cardiology, San Filippo Neri Hospital; Rome; Italy
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Cohen JD, Costa HS, Russo RJ. Determining the risks of magnetic resonance imaging at 1.5 tesla for patients with pacemakers and implantable cardioverter defibrillators. Am J Cardiol 2012; 110:1631-6. [PMID: 22921995 DOI: 10.1016/j.amjcard.2012.07.030] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 11/20/2022]
Abstract
Conventional pacemaker and implantable cardioverter-defibrillator product labeling currently cautions against exposure to magnetic resonance imaging (MRI). However, there is a growing clinical need for MRI, without an acceptable alternative imaging modality in many patients with cardiac devices. The purpose of this study was to determine the risk of MRI at 1.5 T for patients with cardiac devices by measuring the frequency of device failures and clinically relevant device parameter changes. Data from a single-center retrospective review of 109 patients with pacemakers and implantable cardioverter-defibrillators (the MRI group) who underwent 125 clinically indicated MRI studies were compared to data from a prospective cohort of 50 patients with cardiac devices who did not undergo MRI (the control group). In the MRI group, there were no deaths, device failures requiring generator or lead replacement, induced arrhythmias, losses of capture, or electrical reset episodes. Decreases in battery voltage of ≥0.04 V occurred in 4%, pacing threshold increases of ≥0.5 V in 3%, and pacing lead impedance changes of ≥50 Ω in 6%. Although there were statistically significant differences between the MRI and control groups for the mean change in pacing lead impedance (-6.2 ± 23.9 vs 3.0 ± 22.1 Ω) and left ventricular pacing threshold (-0.1 ± 0.3 vs 0.1 ± 0.2 V), these differences were not clinically important. In conclusion, MRI in patients with cardiac devices resulted in no device or lead failures. A small number of clinically relevant changes in device parameter measurements were noted. However, these changes were similar to those in a control group of patients who did not undergo MRI.
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Affiliation(s)
- Jennifer D Cohen
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
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127
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Is cardiac CT a reproducible alternative for cardiac MR in adult patients with a systemic right ventricle? Neth Heart J 2012; 20:456-62. [PMID: 22847041 DOI: 10.1007/s12471-012-0310-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE 20 % of patients with a systemic RV are pacemaker dependent, and unsuitable to undergo cardiac magnetic resonance (CMR). Multidetector row computed tomography (MDCT) could provide a reproducible alternative to CMR in these patients. The aim of this study was to compare variability of MDCT with CMR. METHODS Thirty-five patients with systemic RV underwent either MDCT (n = 15) or CMR (n = 20). Systemic RV volumes and ejection fraction were obtained, and intra- and interobserver variability for both modalities were assessed and compared. RESULTS We found the intra- and interobserver variability of volumes and function measurements of the systemic RV obtained with MDCT to be higher compared with those obtained with CMR. However, these differences in variability were not significant, the only exception being the interobserver variability of systemic RV stroke volume. CONCLUSIONS MDCT provides a reproducible alternative to CMR for volumes and function assessment in patients with a systemic RV.
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128
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Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs 2012; 16:23-33. [PMID: 23104398 DOI: 10.1007/s10047-012-0668-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
The number of pediatric pacemakers implanted is still relatively small. Children requiring pacing therapy have characteristics that are distinct from those of adults, including physical size, somatic growth, and cardiac anomalies. Considering these features, long-term follow-up of pediatric pacemaker implantation is necessary. Selection of appropriate generators, pacing modes, pacing sites, and leads is important. Generally, epicardial leads are commonly used in small infants. On the other hand, the use of endocardial leads in children is increasing worldwide because of their benefits over epicardial leads, such as minimal invasiveness, lower pacing threshold, and longer generator longevity. Endocardial leads are not suitable for patients with intracardiac shunts because of the high risk of systemic thrombosis. Venous occlusion is another significant problem with endocardial leads. With the increase in the number of pacing device implantations, the incidence of infection from such devices is also increasing. Complete device removal is sometimes recommended to treat device infection, but experience in the removal of endocardial leads in children is still scarce. This article gives an overview of pacing therapy in the pediatric population, including discussions on new pacing systems, such as remote monitoring systems, magnetic imaging compliant pacemaker systems, and leadless pacing devices.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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129
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Repeated MRI of a Patient with an Intramedullary Tumour and Implanted Cardiac Resynchronization Therapy Defibrillator (CRT-D). Clin Neuroradiol 2012; 23:237-41. [DOI: 10.1007/s00062-012-0176-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 09/19/2012] [Indexed: 11/26/2022]
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130
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Wollmann CG, Steiner E, Vock P, Ndikung B, Mayr H. Monocenter feasibility study of the MRI compatibility of the Evia pacemaker in combination with Safio S pacemaker lead. J Cardiovasc Magn Reson 2012; 14:67. [PMID: 23009683 PMCID: PMC3482396 DOI: 10.1186/1532-429x-14-67] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility of the magnetic resonance (MR) conditional pacemaker (PM) system (Evia SR-T and DR-T with Safio S leads) under MR conditions. METHODS Patients with standard PM indications and Evia PM were eligible for enrollment in this single center prospective non-randomized pilot study. Patients underwent MR of the brain and lower lumbar spine at 1.5 Tesla. Atrial (RA) und ventricular (RV) lead parameters (sensing, pacing threshold [PTH], pacing impedance) were assessed immediately before (baseline follow-up [FU]) and immediately after MRI (1st FU), after 1 month (2nd FU) and 3 months (3rd FU). The effect of MR on serious adverse device effect (SADE) free-rate, on atrial and ventricular sensing (AS/VS; mV) and atrial (RA) and ventricular (RV) pacing thresholds (PTH; V/0.4 ms) were investigated between baseline and 2nd FU. Continuous variables are expressed as mean ± SD and were compared using paired Student's t-test. A p < 0.05 was considered significant. RESULTS Thirty-one patients were enrolled. One patient had to be excluded because of an enrollment violation. Therefore, data of 30 patients (female 12 [40%], age 73 ± 12 years, dual chamber PM 15 [50%]) were included in this analysis. No MR related SADE occurred. Lead measurements were not statistically different between the baseline FU and the 2nd FU (AS/VS at baseline 3.2 ± 2.1/15.0 ± 6.0, at 2nd FU 3.2 ± 2.1/14.9 ± 6.5; p = ns. RA-PTH/RV-PTH at baseline 0.68 ± 0.18/0.78 ± 0.22, at 2nd FU 0.71 ± 0.24/0.78 ± 0.22; p = ns). The presence of the permanent pacemakers led to MR imaging artifacts on diffusion weighted sequences of the brain, but did not affect other sequences (e.g. FLAIR and T2 weighted spin-echo images). CONCLUSION The use of the MR conditional Evia PM in a MR environment under predefined conditions is feasible. No MR related SADEs nor clinically relevant changes in device functions occurred.
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Affiliation(s)
- Christian G Wollmann
- Hospital of St. Pölten-Lilienfeld, Department of Cardiology, St. Pölten, Austria
- Karl Landsteiner Society, Institute of Research on Ischemic Heart Diseases and Rhythmology, St. Pölten, Austria
| | - Erich Steiner
- Institute of Diagnostic Imaging, Frühwald, Steiner, Obermayer, St. Pölten, Austria
| | - Paul Vock
- Hospital of St. Pölten-Lilienfeld, Department of Cardiology, St. Pölten, Austria
- Karl Landsteiner Society, Institute of Research on Ischemic Heart Diseases and Rhythmology, St. Pölten, Austria
| | | | - Harald Mayr
- Hospital of St. Pölten-Lilienfeld, Department of Cardiology, St. Pölten, Austria
- Karl Landsteiner Society, Institute of Research on Ischemic Heart Diseases and Rhythmology, St. Pölten, Austria
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Cronin EM, Wilkoff BL. Magnetic resonance imaging conditional pacemakers: rationale, development and future directions. Indian Pacing Electrophysiol J 2012; 12:204-12. [PMID: 23071382 PMCID: PMC3443878 DOI: 10.1016/s0972-6292(16)30543-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pacemakers and other cardiac implantable electronic devices (CIEDs) have long been considered an absolute contraindication to magnetic resonance imaging (MRI), a crucial and growing imaging modality. In the last 20 years, protocols have been developed to allow MR scanning of CIED patients with a low complication rate. However, this practice has remained limited to a relatively small number of centers, and many pacemaker patients continue to be denied access to clinically indicated imaging. The introduction of MRI conditional pacemakers has provided a widely applicable and satisfactory solution to this problem. Here, the interactions of pacemakers with the MR environment, the results of MR scanning in patients with conventional CIEDs, the development and clinical experience with MRI conditional devices, and future directions are reviewed.
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MRI-Conditional Cardiac Implantable Electronic Devices: What's New and What Can We Expect in the Future? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:558-64. [PMID: 22851216 DOI: 10.1007/s11936-012-0197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OPINION STATEMENT The use of magnetic resonance imaging (MRI) as a diagnostic technique is rapidly expanding. The number of patients who undergo implantation of permanent pacemaker, implantable cardioverter defibrillator (ICD), and/or cardiac resynchronization therapy devices is increasing in parallel. Cardiovascular implants are subject to potentially harmful effects from MRI, and the routine use of this imaging modality for patients with standard cardiovascular devices is contraindicated. Several recent publications have suggested that MRI can safely be performed in standard cardiovascular device recipients with appropriate patient selection, device programming, and strict monitoring. In addition, MRI "conditional" device systems are now available that are specifically designed to be safe in the MRI environment. Such new technologies may simplify and improve overall safety of MRI in the setting of pacemaker and ICD systems. Although the availability of MRI conditional devices represents a significant breakthrough, their current use is limited to specific MRI conditions. MRI conditional cardiac device technology will likely continue to evolve with increased efforts to improve simplicity, safety, and generalizability under all MRI conditions.
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133
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Dorenkamp M, Roser M, Hamm B, Haverkamp W. [Magnetic resonance imaging and implantable cardiac devices. Current status and future perspectives of MR-compatible systems]. Herz 2012; 37:136-45. [PMID: 22398815 DOI: 10.1007/s00059-012-3588-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional pacemakers and implantable cardioverter-defibrillators (ICD) have always been regarded as a contraindication to magnetic resonance imaging (MRI). MR-compatible systems represent a recent and particularly important innovation, since they will provide device patients with significantly improved access to MR examinations. However, the safe application of MR-compatible technology requires a detailed understanding of the strictly defined cardiologic and radiologic requirements and conditions that are to be adhered to before and during an MR examination. The present article gives an overview of problematic MR interactions with implanted devices, illustrates the most important aspects of MR-compatible pacemaker and ICD systems, analyzes their current clinical status, and offers a critical perspective.
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Affiliation(s)
- M Dorenkamp
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
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134
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Bilchick KC. Integration of CMR scar imaging and electroanatomic mapping: the future of VT ablation? JACC Cardiovasc Imaging 2012; 5:211-3. [PMID: 22340830 DOI: 10.1016/j.jcmg.2011.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/20/2011] [Indexed: 11/20/2022]
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135
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BEINART ROY, NAZARIAN SAMAN. Magnetic Resonance Imaging in Patients with Implanted Devices. J Cardiovasc Electrophysiol 2012; 23:1040-2. [DOI: 10.1111/j.1540-8167.2012.02366.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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136
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Hsu C, Parker G, Puranik R. Implantable devices and magnetic resonance imaging. Heart Lung Circ 2012; 21:358-63. [PMID: 22542861 DOI: 10.1016/j.hlc.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 11/25/2022]
Abstract
The indications for cardiovascular implantable electronic devices (CIEDs) are ever expanding, seemingly in parallel to the similar widespread increase in the use of magnetic resonance imaging (MRI), where there are clear advantages of imaging with no ionizing radiation and superior tissue contrast. However, CIEDs have traditionally been considered an absolute contraindication to MRI, posing a major limitation to investigating various pathologies after implantation of such devices. In the last decade the traditional paradigm of avoiding MRI in patients with CIEDs has been challenged with studies demonstrating relative safety at 1.5T under certain circumstances. Now with the recent approval of 'MR conditional' devices, it is becoming increasingly apparent that CIEDs should no longer be considered an absolute contraindication to MRI.
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Affiliation(s)
- Chijen Hsu
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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137
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Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the medical environment (part II). Clin Cardiol 2012; 35:321-8. [PMID: 22539263 DOI: 10.1002/clc.21997] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/19/2012] [Accepted: 03/19/2012] [Indexed: 11/07/2022] Open
Abstract
Electromagnetic interference produced by medical equipment can interact with implanted cardiac devices such as pacemakers and implantable cardioverter-defibrillators. The most commonly observed interaction is in the operating room with electrosurgery. The risk of interactions can often be mitigated by close communication between the cardiac-device specialist and the anesthesiology/surgical team to develop a patient-specific strategy that accounts for factors such as type of device, type of surgery, and whether the patient is pacemaker dependent. Although magnetic resonance imaging should generally not be used in patients with implanted cardiac devices, several published guidelines provide strategies and recommendations for managing risks if magnetic resonance imaging is required with no suitable diagnostic alternatives. Other common sources of electromagnetic interference in the medical environment are ionizing radiation and left ventricular assist devices.
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Affiliation(s)
- Juna Misiri
- Department of Medicine, Division of Cardiovascular Disease, Electrophysiology and Pacing Service, Mayo Clinic, Jacksonville, Florida, USA
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138
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Arenal A, Hernandez J, Perez-David E, Rubio-Guivernau JL, Ledesma-Carbayo MJ, Fernandez-Aviles F. Do the spatial characteristics of myocardial scar tissue determine the risk of ventricular arrhythmias? Cardiovasc Res 2012; 94:324-32. [DOI: 10.1093/cvr/cvs113] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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139
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Bovenschulte H, Schlüter-Brust K, Liebig T, Erdmann E, Eysel P, Zobel C. MRI in patients with pacemakers: overview and procedural management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:270-5. [PMID: 22567062 DOI: 10.3238/arztebl.2012.0270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is generally contraindicated for patients with a pacemaker (PM) or implantable cardiac defibrillator (ICD), because of the risk of life-threatening interference with the device. Nevertheless, the question whether to perform MRI despite the presence of these devices can still arise when MRI is vitally indicated. In some hospitals, special precautionary measures are taken so that MRI can be performed in such cases. METHODS This review is based on the authors' experience in 42 patients who underwent MRI at our university hospital, on the pertinent literature, and on the recommendations of medical societies. RESULTS Because of its excellent image quality, MRI is often an indispensable diagnostic tool. Structured multidisciplinary management enables it to be performed safely even in patients with a PM or ICD. Pre- and post-MRI checks of the device are recommended, as well as extensive monitoring and the availability of the necessary personnel to deal with an emergency. In general, the pacing and defibrillator functions should be deactivated; for pacemaker-dependent patients, the asynchronous pacing mode should be activated. No serious incidents have occurred when these precautions have been observed, either among our own patients or in the literature. Newer PM systems have been approved for MRI scanning under certain conditions. CONCLUSION In patients with a PM or ICD, the benefit of MRI may far outweigh its risks if the indication has been established for the particular patient as an interdisciplinary decision and if the appropriate precautions are observed during scanning. Now that newer PM systems have been approved for MRI scanning, the problem seems close to being solved.
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140
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Maff S, Paffoni P, Perucca A, Signorotti F, Dellavesa P, Parravicini U. Pseudo ?end of life? indication after electromagnetic field exposure: An unusual effect of magnetic resonance imaging on implanted cardioverter defibrillator. Int J Cardiol 2012; 156:e36-9. [DOI: 10.1016/j.ijcard.2011.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 08/13/2011] [Indexed: 11/29/2022]
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141
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142
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Moens M, Droogmans S, Spapen H, De Smedt A, Brouns R, Van Schuerbeek P, Luypaert R, Poelaert J, Nuttin B. Feasibility of cerebral magnetic resonance imaging in patients with externalised spinal cord stimulator. Clin Neurol Neurosurg 2012; 114:135-41. [DOI: 10.1016/j.clineuro.2011.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 09/22/2011] [Accepted: 09/27/2011] [Indexed: 12/19/2022]
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143
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Jung W, Zvereva V, Hajredini B, Jackle S. Safe magnetic resonance image scanning of the pacemaker patient: current technologies and future directions. Europace 2012; 14:631-7. [DOI: 10.1093/europace/eur391] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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144
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Saeed M, Hetts SW, English J, Wilson M. MR fluoroscopy in vascular and cardiac interventions (review). Int J Cardiovasc Imaging 2012; 28:117-37. [PMID: 21359519 PMCID: PMC3275732 DOI: 10.1007/s10554-010-9774-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/13/2010] [Indexed: 12/22/2022]
Abstract
Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image-guided surgeries that offer improved patient management and cost effectiveness.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107-1701, USA.
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145
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Langman DA, Goldberg IB, Judy J, Paul Finn J, Ennis DB. The dependence of radiofrequency induced pacemaker lead tip heating on the electrical conductivity of the medium at the lead tip. Magn Reson Med 2011; 68:606-13. [PMID: 22213610 DOI: 10.1002/mrm.23235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/31/2011] [Accepted: 09/02/2011] [Indexed: 11/09/2022]
Abstract
Radiofrequency induced pacemaker lead tip heating is one of the main reasons magnetic resonance imaging (MRI) is contraindicated for patients with pacemakers. The objective of this work was to evaluate the dependence of pacemaker lead tip heating during MRI scanning on the electrical conductivity of the medium surrounding the pacemaker lead tip. The effect of conductivity was measured using hydroxyethyl cellulose, polyacrylic acid, and saline with conductivities ranging from 0 to 3 S/m which spans the range of human tissue conductivity. The maximum lead tip heating observed in polyacrylic acid was 50.4 °C at 0.28 S/m, in hydroxyethyl cellulose the maximum was 36.8 °C at 0.52 S/m, and in saline the maximum was 12.5 °C at 0.51 S/m. The maximum power transfer theorem was used to calculate the relative power deposited in the solution based on the characteristic impedance of the pacemaker lead and test solution impedance. The results demonstrate a strong correlation between the relative power deposited and pacemaker lead tip heating for hydroxyethyl cellulose and saline solutions. Maximum power deposition occurred when the impedance of the solution matched the pacemaker lead impedance. Pacemaker lead tip heating is dependent upon the electrical conductivity of the solution at the lead tip and should be considered when planning in vitro gel or saline experiments.
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Affiliation(s)
- Deborah A Langman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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146
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Cardiac imaging: Part 1, MR pulse sequences, imaging planes, and basic anatomy. AJR Am J Roentgenol 2011; 197:808-15. [PMID: 21940567 DOI: 10.2214/ajr.10.7231] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE MRI is a well-established modality for evaluating congenital and acquired cardiac diseases. This article reviews the latest pulse sequences used for cardiac MRI. In addition, the standard cardiac imaging planes and corresponding anatomy are described and illustrated. CONCLUSION Familiarity with the basic pulse sequences, imaging planes, and anatomy pertaining to cardiac MRI is essential to formulate optimal protocols and interpretations.
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147
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Wollmann CG, Thudt K, Vock P, Globits S, Mayr H. Clinical routine implantation of a dual chamber pacemaker system designed for safe use with MRI: a single center, retrospective study on lead performance of Medtronic lead 5086MRI in comparison to Medtronic leads 4592-53 and 4092-58. Herzschrittmacherther Elektrophysiol 2011; 22:233-242. [PMID: 22127540 DOI: 10.1007/s00399-011-0161-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS We report our experience concerning lead performance and re-surgery rate of the Medtronic EnRhythm MRI SureScan pacemaker system (MRI-PM) in comparison to standard pacemaker (PM) systems and leads used at our institution. METHODS All patients (except patients with transvenous left ventricular leads) with successful PM implantation performed at our institution from 1 March 2009 to 31 October 2009 were included in this analysis and followed until mid January 2010. Lead measurements (assessed at implantation, prehospital discharge interrogation (1st follow-up) and at the first scheduled out-patient follow-up (2nd follow-up) were compared between atrial leads 4592-53 cm and 5086MRI-52 cm (lead group 1), and between ventricular leads 4092-58 cm and 5086MRI-52 cm/-58 cm (lead group 2), respectively. Causes for re-operations were assessed and compared between patients with standard dual chamber PM (DC-PM) and the MRI-PM. RESULTS A total of 140 patients (VVI-PM: 36 patients; DDD-PM: 102 patients; biventricular PM: 1 patient) were successfully implanted with a PM within the implantation period. Two patients with transvenous left ventricular leads were excluded from further analysis. In an atrial position, lead 4592 was implanted in 51 patients and lead 5086MRI-52 cm was implanted in 40 patients, respectively. Ventricular leads were lead 4092-58 cm (64 patients) and lead 5086MRI (41 patients), respectively. Patients were followed for 26 ± 11 weeks. Comparison of lead measurements of lead group 1 showed significant differences for pacing impedance and pacing threshold at implantation, and for sensing at the 2nd follow-up. Comparison of lead measurements within lead group 2 showed significant differences for pacing impedance at implantation, for pacing threshold at the 1st follow-up, and for sensing, pacing threshold, and impedance at the 2nd follow-up. All assessed mean values were favorable for all leads at any follow-up. The number of re-operations was high in both dual chamber PM groups, but did not differ significantly between the two groups (DC-PM: 5 patients, 8.5%; MRI-PM: 5 patients, 13.2%). CONCLUSION Our study demonstrates favorable lead measurements of lead model 5086MRI in comparison to lead 4592 and 4092 in a short-term follow-up. The number of re-operations was higher in the MRI-PM group, but not statistically different in comparison with the standard dual chamber PM group.
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Affiliation(s)
- C G Wollmann
- Department of Cardiology, Hospital of St. Pölten-Lilienfeld, Propst Führer-Str. 4, 3100, St. Pölten, Austria.
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148
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Shinbane JS, Colletti PM, Shellock FG. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs. J Cardiovasc Magn Reson 2011; 13:63. [PMID: 22032338 PMCID: PMC3219582 DOI: 10.1186/1532-429x-13-63] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022] Open
Abstract
Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick M Colletti
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
| | - Frank G Shellock
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
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Hogarth AJ, Artis NJ, Sivananthan UM, Pepper CB. Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker. Heart Int 2011; 6:e19. [PMID: 22355486 PMCID: PMC3282436 DOI: 10.4081/hi.2011.e19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/19/2011] [Indexed: 01/09/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is increasingly used as the optimum modality for cardiac imaging. An aging population and rising numbers of patients with permanent pacemakers means many such individuals may require cardiac MRI scanning in the future. Whilst the presence of a permanent pacemaker is historically regarded as a contra-indication to MRI scanning, pacemaker systems have been developed to limit any associated risks. No reports have been published regarding the use of such devices with cardiac MRI in a clinical setting. We present the safe, successful cardiac MRI scan of a patient with an MRI-conditional permanent pacing system.
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150
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Nazarian S, Hansford R, Roguin A, Goldsher D, Zviman MM, Lardo AC, Caffo BS, Frick KD, Kraut MA, Kamel IR, Calkins H, Berger RD, Bluemke DA, Halperin HR. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med 2011; 155:415-24. [PMID: 21969340 PMCID: PMC4337840 DOI: 10.7326/0003-4819-155-7-201110040-00004] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. OBJECTIVE To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. DESIGN Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896) SETTING: One center in the United States (94% of examinations) and one in Israel. PATIENTS 438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. INTERVENTION Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachyarrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist. MEASUREMENTS Activation or inhibition of pacing, symptoms, and device variables. RESULTS In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, -0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, -2 Ω [IQR, -13 to 0 Ω], -4 Ω [IQR, -16 to 0 Ω], and -11 Ω [IQR, -40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, -1.1 to 0.3 mV]), decreased RV lead impedance (median, -3 Ω, [IQR, -29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, -0.01 V, IQR, -0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming. LIMITATIONS Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed. CONCLUSION With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential.
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Affiliation(s)
- Saman Nazarian
- Johns Hopkins University, Baltimore, Maryland 21287, USA.
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