151
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Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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152
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Mascioli G, Lucca E, Michelotti F, Tarantino L, Giofré F, Finamora I. Need for MRI scans in a real-world CIED population over long-term follow-up: Data from a large single-centre experience. PLoS One 2020; 15:e0244672. [PMID: 33378333 PMCID: PMC7773230 DOI: 10.1371/journal.pone.0244672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Giosuè Mascioli
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Elena Lucca
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Luca Tarantino
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Fabrizio Giofré
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Ilaria Finamora
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
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153
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Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. Rev Port Cardiol 2020; 40:41-52. [PMID: 33342713 DOI: 10.1016/j.repc.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/22/2022] Open
Abstract
Magnetic resonance imaging (MRI) is currently considered an essential complementary method for diagnosis in many conditions. Exponential growth in its use is expected due to the aging population and a broader spectrum of clinical indications. Growth in its use, coupled with an increasing number of pacemaker implants, implantable cardioverter-defibrillators and cardiac resynchronization therapy, has led to a frequent clinical need for this diagnostic modality in patients with cardiac implantable electronic devices (CIED). This clinical need has fueled the development of devices specifically designed and approved for use in a magnetic resonance (MR) environment under certain safety conditions (MR-conditional devices). More than a decade after the introduction of the first MR-conditional pacemaker, there are now several dozen MR-conditional devices with different safety specifications. In recent years, increasing evidence has indicated there is a low risk to MRI use in conventional (so-called non-MR-conditional) CIED patients in the right circumstances. The increasing number, as well as the greater diversity and complexity of implanted devices, justify the need to standardize procedures, by establishing institutional agreements that require close collaboration between cardiologists and radiologists. This consensus document, prepared jointly by the Portuguese Society of Cardiology and the Portuguese Society of Radiology and Nuclear Medicine, provides general guidelines for MRI in patients with CIED, ensuring the safety of patients, health professionals and equipment. In addition to briefly reviewing the potential risks of MRI in patients with CIED and major changes to MRI-conditional devices, this article provides specific recommendations on risk-benefit analysis, informed consent, scheduling, programming strategies, devices, monitoring and modification of MRI sequences. The main purpose of this document is to optimize patient safety and provide legal support to facilitate easy access by CIED patients to a potentially beneficial and irreplaceable diagnostic technique.
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Affiliation(s)
- Ana G Almeida
- Serviço de Cardiologia do Hospital Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Natália António
- Unidade de Pacing e Eletrofisiologia, Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Saraiva
- Serviço de Radiologia do Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - António Miguel Ferreira
- Serviço de Cardiologia do Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Unidade de Imagem Cardíaca Avançada, Hospital da Luz, Lisboa, Portugal
| | - António Hipólito Reis
- Laboratório de Pacing e Eletrofisiologia, Hospital Geral de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Hugo Marques
- Serviço de Radiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central; Unidade Imagem Cardíaca Avançada, Hospital da Luz Lisboa; Nova Medical School, Lisboa, Portugal
| | - Nuno Dias Ferreira
- Serviço de Cardiologia do Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Mário Oliveira
- Unidade de Arritmologia, Pacing e Eletrofisiologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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154
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Arcario MJ, Lou S, Taylor P, Gregory SH. Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations. J Cardiothorac Vasc Anesth 2020; 35:3340-3349. [PMID: 33431271 DOI: 10.1053/j.jvca.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022]
Abstract
The sinuses of Valsalva are outpouchings in the aortic root just distal to the aortic valve that serve several physiologic functions. Aneurysm of this segment of the aorta is quite rare and infrequently encountered in clinical practice. Due to the rarity of sinus of Valsalva aneurysms, there is a lack of controlled trials and most of the literature consists of case reports and series. Here, the authors review the currently available literature to discuss the anatomy and normal function of the aortic root, as well as disease pathology and diagnostic imaging considerations. Using reported cases, the authors also will discuss considerations for cardiac anesthesiologists in the perioperative period.
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Affiliation(s)
- Mark J Arcario
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Sunny Lou
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Phillip Taylor
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Stephen H Gregory
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO.
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155
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Case Report: Adjuvant Breast Cancer Radiation Therapy in a Patient With an Implanted Deep Brain Stimulation Device. Adv Radiat Oncol 2020; 5:1380-1383. [PMID: 33305103 PMCID: PMC7718492 DOI: 10.1016/j.adro.2020.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022] Open
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156
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Ohno T, Soejima T, Sekiguchi Y, Hashimoto T, Koike I, Matsubara H, Nakamura K, Nitta K, Takahashi S, Tsujino K, Wakatsuki M, Yoden E. JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices. JOURNAL OF RADIATION RESEARCH 2020; 62:172-184. [PMCID: PMC7779359 DOI: 10.1093/jrr/rraa102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/19/2020] [Indexed: 06/12/2023]
Abstract
This publication is an English version of the Japanese Society for Radiation Oncology (JASTRO) and The Japanese Circulation Society official guidelines for patients with cardiac implantable electronic devices (CIEDs). Several radiotherapy-associated malfunctions have been reported for CIEDs such as pacemakers and implantable cardioverter-defibrillators. Accordingly, guidelines for radiotherapy in patients with CIEDs have been issued by other countries and societies. In August 2010, JASTRO published the ‘Radiotherapy Guidelines for Patients with Pacemakers and Implantable Defibrillators’ (hereafter referred to as the former guidelines). Given new findings in this decade, a multidisciplinary working group of radiation oncologists, medical physicists, radiation therapists and cardiologists jointly reviewed and revised the former guidelines.
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Affiliation(s)
- Toshiki Ohno
- Corresponding author. Dokkyo medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan. Tel: +81-282-86-1111;
| | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8 Minatojima Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Department of Cardiology, 1-1–1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Hokkaido University Faculty of Medicine, Kita 15-jo Nishi 7-chome, Kita-ku, Sapporo 060-8638, Japan
| | - Izumi Koike
- Departments of Radiology, Yokohama City University Graduate School of Medicine, 22-2 Seto, Kanazawa-ku, Yokohama, Kanagawa 236-0027, Japan
| | - Hiroaki Matsubara
- Department of Radiation Oncology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Kazunori Nitta
- Ibaraki Prefectural Central Hospital and Cancer Center, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Shigeo Takahashi
- Department of Radiation Oncology, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793 Japan
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, 1-2-1 Koto, Shingu-cho, Tatsuno-shi, Hyogo 679-5165, Japan
| | - Masaru Wakatsuki
- Department of Radiology, Jichi medical university, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Eisaku Yoden
- Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
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157
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MR safety considerations for patients undergoing prostate MRI. Abdom Radiol (NY) 2020; 45:4097-4108. [PMID: 32902658 DOI: 10.1007/s00261-020-02730-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/15/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Over the past decade, there has been a dramatic increase in the number of patients undergoing prostate MRI scans. Patients presenting for prostate MRI are an ageing population and may present with a variety of passive or active implants and devices. These implants and devices can be MR safe or MR conditional or MR unsafe. Patients with certain MR-conditional active implants and devices can safely obtain prostate MRI in a specified MR environment within specific MR imaging parameters. Prostate MRI and PET-MRI in patients with passive implants such as hip prostheses, fiducial markers for SBRT, brachytherapy seeds and prostatectomy bed clips have unique concerns for image optimization that can cause geometric distortion of the diffusion-weighted imaging (DWI) sequence. We discuss strategies to overcome these susceptibility artifacts. Prostate MRI in patients with MR conditional active implants such as cardiac implantable electronic devices (CIED) also require modification of imaging parameters and magnet strength. In this setting, a diagnostic quality prostate MRI can be performed at a lower magnet strength (1.5 T) along with modification of imaging parameters to ensure patient safety. Imaging strategies to minimize susceptibility artifact and decrease the specific absorption rate (SAR) in both settings are described. Knowledge of MR safety considerations and imaging strategies specific to prostate MRI and PET-MRI in patients with implants and devices is essential to ensure diagnostic-quality MR images and patient safety.
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158
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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159
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Lebel K, Mondesert B, Robillard J, Pham M, Terrone D, Tan S. 2020 MR Safety for Cardiac Devices: An Update for Radiologists. Can Assoc Radiol J 2020; 72:814-830. [DOI: 10.1177/0846537120967701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.
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Affiliation(s)
- Kiana Lebel
- The University of Sherbrooke, Montreal, Quebec, Canada
| | | | | | - Magali Pham
- Montreal Heart Institute, Montreal, Quebec, Canada
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160
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Augusto JB, Manisty C. Breaking down the barriers: Re-evaluating risk of MRI in patients with cardiac implantable electronic devices via collaborative practice. Rev Port Cardiol 2020; 40:53-55. [PMID: 33239256 DOI: 10.1016/j.repc.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- João B Augusto
- Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal; Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, London, UK.
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161
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Schwartz SM, Pathrose A, Serhal AM, Ragin AB, Charron J, Knight BP, Passman RS, Avery RJ, Kim D. Evaluation of image quality of wideband single-shot late gadolinium-enhancement MRI in patients with a cardiac implantable electronic device. J Cardiovasc Electrophysiol 2020; 32:138-147. [PMID: 33146422 DOI: 10.1111/jce.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While wideband segmented, breath-hold late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) has been shown to suppress image artifacts associated with cardiac-implanted electronic devices (CIEDs), it may produce image artifacts in patients with arrhythmia and/or dyspnea. Single-shot LGE is capable of suppressing said artifacts. We sought to compare the performance of wideband single-shot free-breathing LGE against the standard and wideband-segmented LGEs in CIED patients. METHODS AND RESULTS We retrospectively identified all 54 consecutive patients (mean age: 61 ± 15 years; 31% females) with CIED who had undergone CMR with standard segmented, wideband segmented, and/or wideband single-shot LGE sequences as part of quality assurance for determining best clinical practice at 1.5 T. Two raters independently graded the conspicuity of myocardial scar or normal myocardium and the presence of device artifact level on a 5-point Likert scale (1: worst; 3: acceptable; 5: best). Summed visual score (SVS) was calculated as the sum of conspicuity and artifact scores (SVS ≥ 6 defined as diagnostically interpretable). Median conspicuity and artifact scores were significantly better for wideband single-shot LGE (F = 24.2, p < .001) and wideband-segmented LGE (F = 20.6, p < .001) compared to standard-segmented LGE. Among evaluated myocardial segments, 72% were deemed diagnostically interpretable-defined as SVS ≥ 6-for standard-segmented LGE, 89% were deemed diagnostically interpretable for wideband-segmented LGE, and 94% segments were deemed diagnostically interpretable for wideband single-shot LGE. CONCLUSIONS Wideband single-shot LGE and wideband-segmented LGE produced similarly improved image quality compared to standard LGE.
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Affiliation(s)
- Sarah M Schwartz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali M Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann B Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Charron
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley P Knight
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan J Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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162
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Gauter-Fleckenstein B, Barthel C, Büttner S, Wenz F, Borggrefe M, Tülümen E. Effectivity and applicability of the German DEGRO/DGK-guideline for radiotherapy in CIED-bearing patients. Radiother Oncol 2020; 152:208-215. [DOI: 10.1016/j.radonc.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/07/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
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163
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MR Imaging Safety in the Interventional Environment. Magn Reson Imaging Clin N Am 2020; 28:583-591. [PMID: 33040998 DOI: 10.1016/j.mric.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interventional MR imaging procedures are rapidly growing in number owing to the excellent soft tissue resolution of MR imaging, lack of ionizing radiation, hardware and software advancements, and technical developments in MR imaging-compatible robots, lasers, and ultrasound equipment. The safe operation of an interventional MR imaging system is a complex undertaking, which is only possible with multidisciplinary planning, training, operations and oversight. Safety for both patients and operators is essential for successful operations. Herein, we review the safety concerns, solutions and challenges associated with the operation of a modern interventional MR imaging system.
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164
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Abstract
Magnetic resonance (MR) imaging relies on a strong static magnetic field in conjunction with careful orchestration of pulsed linear gradient magnetic fields and radiofrequency magnetic fields in order to generate images. The interaction of these fields with patients as well as materials with magnetic or conducting properties can be a source of risk in the MR environment. This article provides a basic review of the physical underpinnings of the primary risks in MR imaging to foster development of intuition with respect to both patient and risk management in the MR environment.
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Affiliation(s)
- Roger Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1472, Houston, TX 77030, USA.
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165
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Carter SV, Jameria Z, Karagodin I, Tung R, Upadhyay GA. Real-world safety of magnetic resonance imaging after His bundle pacemaker implantation. HeartRhythm Case Rep 2020; 6:697-701. [PMID: 33101935 PMCID: PMC7573342 DOI: 10.1016/j.hrcr.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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166
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Peshock RM. Clearing the Path to Optimal Care in Patients with Non-MRI-conditional Cardiac Devices. Radiol Cardiothorac Imaging 2020; 2:e200560. [PMID: 33779664 PMCID: PMC7977869 DOI: 10.1148/ryct.2020200560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Ronald M. Peshock
- From the Departments of Radiology and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390
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167
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kovach C, Swirka M, McGuinn E, Honce JM, Groves DW, Tumolo AZ. Magnetic resonance imaging in a patient with temporary external pacemaker. HeartRhythm Case Rep 2020; 6:637-640. [PMID: 32983883 PMCID: PMC7498632 DOI: 10.1016/j.hrcr.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Christopher Kovach
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Mallory Swirka
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Erin McGuinn
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Justin M Honce
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado
| | - Daniel W Groves
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado.,Department of Radiology, University of Colorado Hospital, Aurora, Colorado
| | - Alexis Z Tumolo
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
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Dacher JN, Gandjbakhch E, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Boveda S, Jacquier A. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices. Diagn Interv Imaging 2020; 101:507-517. [PMID: 32094095 DOI: 10.1016/j.diii.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.
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Affiliation(s)
- J-N Dacher
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France.
| | - E Gandjbakhch
- Sorbonne Universités, AP-HP, Heart Institute, La Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - J Taieb
- Hospital of Aix-en-Provence, Department of Cardiology, 13100 Aix-en-Provence, France
| | - M Chauvin
- Université de Strasbourg, CHU Strasbourg, Department of Cardiology, 67000 Strasbourg, France
| | - F Anselme
- Normandie UNIV, UNIROUEN, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - A Bartoli
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
| | - L Boyer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - L Cassagnes
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - H Cochet
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - B Dubourg
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France
| | - L Fauchier
- Université de Tours, CHU de Tours, Department of Cardiology, 37000 Tours, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Department of Cardiology, 44200 Nantes, France
| | - D Klug
- Université de Lille, CHRU de Lille, Department of Cardiology, 59000 Lille, France
| | - G Laurent
- Université de Dijon, CHU de Dijon, Department of Cardiology, 21000 Dijon, France
| | - J Mansourati
- Université de Bretagne Occidentale, CHU de Brest, Department of Cardiology, 29200 Brest, France
| | - E Marijon
- Université de Paris, AP-HP, Department of Cardiology, Georges-Pompidou European University Hospital, 75015 Paris, France
| | - P Maury
- Université de Toulouse, Inserm U1048, Department of Cardiology, Hospital Rangueil, 31059 Toulouse, France
| | - O Piot
- Centre Cardiologique du Nord, Department of Cardiology, 93200 Saint-Denis, France
| | - F Pontana
- Université de Lille, Inserm U1011, Department of Cardiovascular Radiology, Institut Cœur-Poumon, 59000 Lille, France
| | - F Sacher
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - N Sadoul
- Université de Nancy Lorraine, CHU de Nancy, Department of Cardiology, 54511 Vandœuvre-lès-Nancy, France
| | - S Boveda
- Clinique Pasteur, Department of Cardiology, 31076 Toulouse, France
| | - A Jacquier
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
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170
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Malavasi VL, De Marco G, Imberti JF, Placentino F, Vitolo M, Mazzeo E, Cicoria G, Casali E, Turco V, Lohr F, Boriani G. Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients. Intern Emerg Med 2020; 15:967-973. [PMID: 31792775 DOI: 10.1007/s11739-019-02240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was < 2 Gy. Two malfunctions occurred in the 37 patients treated with neutron-producing RT (5.4%), and 1 malfunction occurred in the 102 patients treated with non-neutron-producing RT (1%) (p = 0.17). Device relocation from the RT field was performed in 2/127 (1.6%) patients. RT in patients with CIED is substantially safe if performed in an appropriately organized environment, with uncommon CIEDs malfunctions and no major clinical events. Neutron-producing energies, rather than Dmax, seem to increase the risk of malfunctions. Device interrogation on a regular basis is advised to promptly manage CIED malfunctions.
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Affiliation(s)
- Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giuseppina De Marco
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Filippo Placentino
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Ercole Mazzeo
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | | | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Vincenzo Turco
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Frank Lohr
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
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171
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Radioactivity induced in new-generation cardiac implantable electronic devices during high-energy X-ray irradiation. Appl Radiat Isot 2020; 163:109206. [DOI: 10.1016/j.apradiso.2020.109206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 01/17/2023]
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172
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Cronin B, Dalia A, Nguyen QS, Sandoval K, Birgersdotter-Green U, Maus T, Essandoh MK. Perioperative Interrogation of Medtronic Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:2465-2475. [DOI: 10.1053/j.jvca.2019.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022]
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173
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Vigen KK, Reeder SB, Hood MN, Steckner M, Leiner T, Dombroski DA, Gulani V. Recommendations for Imaging Patients With Cardiac Implantable Electronic Devices (CIEDs). J Magn Reson Imaging 2020; 53:1311-1317. [PMID: 32808391 DOI: 10.1002/jmri.27320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022] Open
Abstract
Historically, the presence of cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators (ICDs), was widely considered an absolute contraindication to magnetic resonance imaging (MRI). The recent development of CIEDs with MR Conditional labeling, as well as encouraging results from retrospective studies and a prospective trial on the safety of MRI performed in patients with CIEDs without MR Conditional labeling, have led to a reevaluation of this practice. The purpose of this report is to provide a concise summary of recent developments, including practical guidelines that an institution could adopt for radiologists who choose to image patients with CIEDs that do not have MR Conditional labeling. This report was written on behalf of and approved by the International Society for Magnetic Resonance in Medicine (ISMRM) Safety Committee. LEVEL OF EVIDENCE: 3. TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Karl K Vigen
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maureen N Hood
- Department of Radiology & Radiological Sciences, Uniformed Services University, Bethesda, Maryland, USA
| | | | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - David A Dombroski
- Department of Radiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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174
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Ning X, Li X, Fan X, Chen K, Hua W, Liu Z, Dai Y, Chen X, Lu M, Zhao S, Zhang S. 3.0 T magnetic resonance imaging scanning on different body regions in patients with pacemakers. J Interv Card Electrophysiol 2020; 61:545-550. [PMID: 32808082 DOI: 10.1007/s10840-020-00854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers. METHODS Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists. RESULTS Twenty-three MRI scans of different body regions (brain = 13, lumbar spine = 4, cervical spine = 2, and heart = 4) were performed, and the average time of a scan was 25 ± 11 min. No significant changes in sensing amplitude (atrial 3.1 ± 1.1 mV vs. 2.9 ± 1.2 mV, P = 0.71; ventricular 9.3 ± 3.5 mV vs. 10.2 ± 3.4 mV, P = 0.46), lead impedances (atrial 647 ± 146 Ω vs. 627 ± 151 Ω, P = 0.7; ventricular: 780 ± 247 Ω vs.711 ± 226 Ω, P = 0.36), or pacing threshold (atrial 0.6 ± 0.2 V/0.4 ms vs. 0.6 ± 0.2 V/0.4 ms, P = 0.71; ventricular 0.7 ± 0.3 V/0.4 ms vs. 0.7 ± 0.2 V/0.4 ms, P = 0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value. CONCLUSION Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.
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Affiliation(s)
- Xiaohui Ning
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaofei Li
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaohan Fan
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China.
| | - Keping Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Zhimin Liu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Yan Dai
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shihua Zhao
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
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175
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Hu Q, Yu VY, Yang Y, Hu P, Sheng K, Lee PP, Kishan AU, Raldow AC, O'Connell DP, Woods KE, Cao M. Practical Safety Considerations for Integration of Magnetic Resonance Imaging in Radiation Therapy. Pract Radiat Oncol 2020; 10:443-453. [PMID: 32781246 DOI: 10.1016/j.prro.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022]
Abstract
Interest in integrating magnetic resonance imaging (MRI) in radiation therapy (RT) practice has increased dramatically in recent years owing to its unique advantages such as excellent soft tissue contrast and capability of measuring biological properties. Continuous real-time imaging for intrafractional motion tracking without ionizing radiation serves as a particularly attractive feature for applications in RT. Despite its many advantages, the integration of MRI in RT workflows is not straightforward, with many unmet needs. MR safety remains one of the key challenges and concerns in the clinical implementation of MR simulators and MR-guided radiation therapy systems in radiation oncology. Most RT staff are not accustomed to working in an environment with a strong magnetic field. There are specific requirements in RT that are different from diagnostic applications. A large variety of implants and devices used in routine RT practice do not have clear MR safety labels. RT-specific imaging pulse sequences focusing on fast acquisition, high spatial integrity, and continuous, real-time acquisition require additional MR safety testing and evaluation. This article provides an overview of MR safety tailored toward RT staff, followed by discussions on specific requirements and challenges associated with MR safety in the RT environment. Strategies and techniques for developing an MR safety program specific to RT are presented and discussed.
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Affiliation(s)
- Qiongge Hu
- Department of Radiation Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Victoria Y Yu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Peng Hu
- Department of Radiology, University of California, Los Angeles, California
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Percy P Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Ann C Raldow
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Dylan P O'Connell
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Kaley E Woods
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California.
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176
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Padmanabhan D, Kella D, Isath A, Tandon N, Mulpuru S, Deshmukh A, Kapa S, Mehta R, Dalzell C, Olson N, Felmlee J, Jondal ML, Asirvatham SJ, Watson RE, Cha YM, Friedman P. Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators. J Cardiovasc Electrophysiol 2020; 31:2931-2939. [PMID: 32757438 DOI: 10.1111/jce.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/11/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients. METHODS This is a single-center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database. The outcomes were classified as aiding in diagnosis, treatment, or both for the patients attributable to the MRI. We then assessed the incidence of adverse effects (AE) when the MRI was performed. RESULTS In 668, MRIs performed on 479 patients, only 13 (1.9%) MRIs did not aid in the diagnosis or treatment of the patient. Power-on reset events without clinical sequelae in three scans (0.45%) were the only AE. The probability of an adverse event happening without any benefit from the MRI scan was 1.1 × 10-4 . A maximum benefit in diagnosis using MRI was obtained in ruling out space-occupying lesions (121/185 scans, 65.4%). Scans performed in patients for elucidating answers to queries in treatment were most frequently done for disease staging at long term follow-up (167/470 scans, 35.5%). Conservative treatment (184/470 scans, 39%) followed by medication changes (153/470 scans, 28.7%) were the most common treatment decisions made. CONCLUSIONS The utility of MRI in patients with non-MRI-conditional CIEDs far outweighs the risk of adverse events when imaging is done in the context of a multidisciplinary program that oversees patient safety.
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Affiliation(s)
- Deepak Padmanabhan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Danesh Kella
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ameesh Isath
- Department of Medicine, Mount Sinai Morningside, New York City, New York, USA
| | - Nidhi Tandon
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramila Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Connie Dalzell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nora Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel Felmlee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary L Jondal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert E Watson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong M Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Position paper concerning the competence, performance and environment required for the practice of ablation in children and in congenital heart disease. Arch Cardiovasc Dis 2020; 113:492-502. [DOI: 10.1016/j.acvd.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/26/2019] [Accepted: 02/06/2020] [Indexed: 11/21/2022]
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178
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Browne JE, Tiegs-Heiden CA, Lehman VT, Long Z, Hangiandreou NJ, Watson RE, Hesley GK, Gorny KR. Magnetic Resonance Imaging–Guided Focused Ultrasound Ablation of Lumbar Facet Joints of a Patient With a Magnetic Resonance Image Non-Conditional Pacemaker at 1.5T. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:464-468. [PMID: 32793874 PMCID: PMC7411156 DOI: 10.1016/j.mayocpiqo.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Patient and Methods Results Conclusion
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179
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Sharifzadehgan A, Laurans M, Thuillot M, Huertas A, Baudinaud P, Narayanan K, Mirabel M, Bibault JE, Frey P, Waldmann V, Varlet E, Amet D, Juin C, Lavergne T, Jouven X, Giraud P, Durdux C, Marijon E. Radiotherapy in Patients With a Cardiac Implantable Electronic Device. Am J Cardiol 2020; 128:196-201. [PMID: 32650920 DOI: 10.1016/j.amjcard.2020.04.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Recently, the Heart Rhythm Society published recommendations on management of patients with cardiac implantable electronic device (CIED) who require radiotherapy (RT). We aimed to report the experience of a teaching hospital, and discuss our practice in the context of recently published guidelines. We identified all consecutive CIED recipients (12,736 patients) who underwent RT between March 2006 and June 2017. Among them, 90 (1%) patients (78.2 ± 10 years, 73% male) had a CIED: 82 pacemakers and 8 implantable cardioverter-defibrillators. Two patients required CIED extraction prior to RT for ipsilateral breast cancer (no device replacement in 1 patient). Four patients (5%) were considered at high-risk, 35 (39%) at intermediate-risk, and the remaining 50 (56%) at low-risk for CIED dysfunction. Overall, only a minority of patients followed recommended local protocol during RT delivery (31%) and during follow-up (56%). CIED malfunction was detected in 5 patients (6%), mainly back-up mode resetting (80%), with 4 (including 3 pelvic cancer location) patients initially classified as being at intermediate-risk and 1 at low-risk. Four out of the 5 patients with CEID malfunction had received neutron producing beams. In conclusion, our findings underline the lack of rigorous monitoring of patients undergoing RT (though CIED malfunction appears to be rare and relatively benign in nature), and emphasize the interest of considering neutron producing beam for risk stratification as recommended in recent guidelines. Optimization of patient's management requires a close collaboration between both CIED clinicians and radiation oncologists, and more systematic remote CIED monitoring may be helpful.
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Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions. J Thorac Imaging 2020; 35:W1-W17. [PMID: 31855948 DOI: 10.1097/rti.0000000000000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.
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Gakenheimer‐Smith L, Etheridge SP, Niu MC, Ou Z, Presson AP, Whitaker P, Su J, Puchalski MD, Asaki SY, Pilcher T. MRI in pediatric and congenital heart disease patients with CIEDs and epicardial or abandoned leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:797-804. [DOI: 10.1111/pace.13984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Susan P. Etheridge
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Mary C. Niu
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Zhining Ou
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | - Angela P. Presson
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | | | - Jason Su
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Michael D. Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Sarah Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
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Bouter J, Lacroix J, Baud J, Thariat J. Une IRM peut être prescrite en situation de dispositif cardiaque implantable (pacemaker, défibrillateur), application à la radiothérapie. Cancer Radiother 2020; 24:340-344. [DOI: 10.1016/j.canrad.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 10/24/2022]
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Falco MD, Genovesi D, Caravatta L, Di Carlo C, Bliakharskaia E, Appignani M, Faustino M, Furia N, Di Girolamo E. A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy. Strahlenther Onkol 2020; 197:198-208. [PMID: 32561941 DOI: 10.1007/s00066-020-01651-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE High-dose 6‑MV radiotherapy may cause cardiac implantable electronic devices (CIEDs) to malfunction. To assess CIED malfunctions resulting from direct exposure up to 10 Gy, 100 pacemakers (PMs) and 40 implantable cardioverter-defibrillators (ICDs) were evaluated. MATERIALS AND METHODS CIEDs underwent baseline interrogation. In ICDs, antitachycardia therapies were disabled via the programmer while the detection windows were left enabled. A computed tomography (CT) scan was performed to build the corresponding treatment plan. CIEDs were "blinded" and randomized to receive single doses of either 2, 5, or, 10 Gy via a 6-MV linear accelerator (linac) in a water phantom. Twenty-two wireless telemetry-enabled CIEDs underwent a real-time session, and their function was recorded by the video camera in the bunker. The CIEDs were interrogated after exposure and once monthly for 6 months. RESULTS During exposure, regardless of dose, 90.9% of the CIEDs recorded electromagnetic interference, with 6 ICDs (27.3%) reporting pacing inhibition and inappropriate arrhythmia detections. After exposure, a backup reset was observed in 1 PM (0.7% overall, 1% among PMs), while 7 PMs (5% overall, 7% among PMs) reported battery issues (overall immediate malfunction rate was 5.7%). During follow-up, 4 PMs (2.9% overall; 4% among PMs) and 1 ICD (0.7% overall; 2.5% among ICDs) reported abnormal battery depletion, and 1 PM (0.7% overall; 1% among PMs) reported a backup reset (overall late malfunction rate was 4.3%). CONCLUSION Apart from transient electromagnetic interference, last-generation CIEDs withstood direct 6‑MV exposure up to 10 Gy. Permanent battery or software errors occurred immediately or later only in less recent CIEDs.
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Affiliation(s)
- Maria Daniela Falco
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy.
| | - Domenico Genovesi
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Ekaterina Bliakharskaia
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Nanda Furia
- Arrhythmology Unit, "SS. Annunziata" Hospital, Chieti, Italy
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Gandjbakhch E, Dacher JN, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Defaye P, Deharo JC, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Jacquier A, Boveda S. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging on magnetic resonance imaging in patients with cardiac electronic implantable devices. Arch Cardiovasc Dis 2020; 113:473-484. [DOI: 10.1016/j.acvd.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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Aslian H, Kron T, Watts T, Akalanli C, Hardcastle N, Lonski P, Montaseri A, Hay B, Korte J, Berk K, Longo F, Severgnini M. The effect of stereotactic body radiotherapy (SBRT) using flattening filter-free beams on cardiac implantable electronic devices (CIEDs) in clinical situations. J Appl Clin Med Phys 2020; 21:121-131. [PMID: 32277741 PMCID: PMC7324704 DOI: 10.1002/acm2.12873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study focused on determining risks from stereotactic radiotherapy using flattening filter-free (FFF) beams for patients with cardiac implantable electronic device (CIEDs). Two strategies were employed: a) a retrospective analysis of patients with CIEDs who underwent stereotactic radiosurgery (SRS)/SBRT at the Peter MacCallum Cancer Centre between 2014 and 2018 and b) an experimental study on the impact of FFF beams on CIEDs. METHODS A retrospective review was performed. Subsequently, a phantom study was performed using 30 fully functional explanted CIEDs from two different manufacturers. Irradiation was carried out in a slab phantom with 6-MV and 10-MV FFF beams. First, a repetition-rate test (RRT) with a range of beam pulse frequencies was conducted. Then, multifraction SBRT (48 Gy/4 Fx) and single-fraction SBRT (28 Gy/1 Fx) treatment plans were used for lung tumors delivered to the phantom. RESULTS Between 2014 and 2018, 13 cases were treated with an FFF beam (6 MV, 1400 MU/min or 10 MV, 2400 MU/min), and 15 cases were treated with a flattening filter (FF) beam (6 MV, 600 MU/min). All the devices were positioned outside the treatment field at a distance of more than 5 cm, except for one case, and no failures were reported due to SBRT/SRS. In the phantom rep-rate tests, inappropriate sensing occurred, starting at a rep-rate of 1200 MU/min. Cardiac implantable electronic device anomalies during and after delivering VMAT-SBRT with a 10-MV FFF beam were observed. CONCLUSIONS The study showed that caution should be paid to managing CIED patients when they undergo SBRT using FFF beams, as it is recommended by AAPM TG-203. Correspondingly, it was found that for FFF beams although there is small risk from dose-rate effects, delivering high dose of radiation with beam energy greater than 6 MV and high-dose rate to CIEDs positioned in close vicinity of the PTV may present issues.
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Affiliation(s)
| | - Tomas Kron
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - Troy Watts
- Department of CardiologyRoyal Melbourne HospitalMelbourneAustralia
| | - Cagla Akalanli
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | | | - Peta Lonski
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - Atousa Montaseri
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - Barry Hay
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - James Korte
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - Kemal Berk
- Physical SciencesPeter MacCallum Cancer CentreMelbourneAustralia
| | - Francesco Longo
- Department of PhysicsUniversity of TriesteTriesteItaly
- Italian National Institute of Nuclear Physics (INFN)sezione di TriesteTriesteItaly
| | - Mara Severgnini
- Department of Medical PhysicsAzienda Sanitaria Universitaria Integrata di TriesteTriesteItaly
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Nakamura K, Aoyama T, Kaneda N, Otsuji M, Minami Y, Sakuragi A, Nakamura M. Effect of X-ray dose rates higher than 8 Gy/min on the functioning of cardiac implantable electronic devices. JOURNAL OF RADIATION RESEARCH 2020; 61:419-425. [PMID: 32253430 PMCID: PMC7299257 DOI: 10.1093/jrr/rraa016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/12/2019] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
Direct irradiation may cause malfunctioning of cardiac implantable electronic devices (CIEDs). Therefore, a treatment plan that does not involve direct irradiation of CIEDs should be formulated. However, CIEDs may be directly exposed to radiation because of the sudden intrafractional movement of the patient. The probability of CIED malfunction reportedly depends on the dose rate; however, reports are only limited to dose rates ≤8 Gy/min. The purpose of this study was to investigate the effect of X-ray dose rates >8 Gy/min on CIED function. Four CIEDs were placed at the center of the radiation field and irradiated using 6 MV X-ray with flattening filter free (6 MV FFF) and 10 MV X-ray with flattening filter free (10 MV FFF). The dose rate was 4-14 Gy/min for the 6 MV FFF and 4-24 Gy/min for 10 MV FFF beams. CIED operation was evaluated with an electrocardiogram during each irradiation. Three CIEDs malfunctioned in the 6 MV FFF condition, and all four CIEDs malfunctioned in the 10 MV FFF condition, when the dose rate was >8 Gy/min. Pacing inhibition was the malfunction observed in all four CIEDs. Malfunction occurred simultaneously along with irradiation and simultaneously returned to normal function on stopping the irradiation. An X-ray dose rate >8 Gy/min caused a temporary malfunction due to interference. Therefore, clinicians should be aware of the risk of malfunction and manage patient movement when an X-ray dose rate >8 Gy/min is used for patients with CIEDs.
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Affiliation(s)
- Kazuhiko Nakamura
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681 Japan
| | - Naoki Kaneda
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
| | - Masashi Otsuji
- Department of Clinical Engineering, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
| | - Yoshitaka Minami
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
| | - Ami Sakuragi
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
| | - Masaru Nakamura
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195 Japan
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Holtstiege V, Meier C, Bietenbeck M, Chatzantonis G, Florian A, Köbe J, Reinke F, Eckardt L, Yilmaz A. 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. J Cardiovasc Magn Reson 2020; 22:35. [PMID: 32418537 PMCID: PMC7232845 DOI: 10.1186/s12968-020-00626-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) studies in patients with implanted cardioverter/defibrillators (ICD) are increasingly required in daily clinical practice. However, the clinical experience regarding the feasibility as well as clinical value of CMR studies in patients with subcutaneous ICD (S-ICD) is still limited. Besides safety issues, image quality and analysis can be impaired primarily due the presence of image artefacts associated with the generator. METHODS Twenty-three patients with an implanted S-ICD (EMBLEM, Boston Scientific, Marlborough, Massachusetts, USA; MR-conditional) with suspected cardiomyopathy and/or myocarditis underwent multi-parametric CMR imaging. Studies were performed on a 1.5 T CMR scanner after device interrogation and comprised standard a) balanced steady state free precession cine, b) T2 weighted-edema, c) velocity-encoded cine flow, d) myocardial perfusion, e) late-gadolinium-enhancement (LGE)-imaging and f) 3D-CMR angiography of the aorta. In case of substantial artefacts, alternative CMR techniques such as spoiled gradient-echo cine-sequences and wide-band inversion-recovery LGE (wb-LGE) sequences were applied. RESULTS Successful CMR studies could be performed in all patients without any case of unexpected early termination or relevant technical complication other than permanent loss of the S-ICD system beeper volume in 52% of our patients. Assessment of cine-CMR images was predominantly impaired in the left ventricular (LV) anterior, lateral and inferior wall segments and a switch to spoiled gradient echo-based cine-CMR allowed an accurate assessment of cine-images in N = 17 (74%) patients with only limited artefacts. Hyperintensity artefacts in conventional LGE-images were predominantly observed in the LV anterior, lateral and inferior wall segments and image optimisation by use of the wb-LGE was helpful in 15 (65%) cases. Aortic flow measurements and 3D-CMR angiography were assessable in all patients Perfusion imaging artefacts precluded a meaningful assessment in at least one half of the patients. A benefit in clinical-decision making was documented in 17 (74%) patients in the present study. CONCLUSION Safe 1.5 T CMR imaging was possible in all patients with an S-ICD, though the majority had permanent loss of the S-ICD beeper volume. Achieving good image quality may be challenging in some patients - particularly for perfusion imaging. Using spoiled gradient echo-based cine-sequences and wb-LGE sequences may help to reduce the extent of artefacts, thereby allowing accurate cardiac assessment. Thus, 1.5 T CMR studies should not be withhold in patients with S-ICD for safety concerns and/or fear of extensive imaging artefacts precluding successful image analysis.
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Affiliation(s)
- Viktoria Holtstiege
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Grigorios Chatzantonis
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Anca Florian
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
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Lindemann F, Oebel S, Paetsch I, Arya A, Dagres N, Richter S, Dinov B, Hilbert S, Loebe S, Stegmann C, Doering M, Bollmann A, Hindricks G, Jahnke C. Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms. J Cardiovasc Magn Reson 2020; 22:32. [PMID: 32389126 PMCID: PMC7212569 DOI: 10.1186/s12968-020-00609-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).
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Affiliation(s)
- Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Susanne Loebe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Clara Stegmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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Abstract
OBJECTIVE. Patients with cardiac implantable electronic devices (CIEDs) require cardiac MRI (CMRI) for a variety of reasons. The purpose of this study is to review and evaluate the value and safety of CMRI for patients with in situ CIEDs. CONCLUSION. Late gadolinium enhancement CMRI is the reference standard for assessing myocardial viability in patients with ventricular tachycardia before ablation of arrhythmogenic substrates. The use of late gadolinium enhancement CMRI for patients with CIEDs is safe as long as an imaging protocol is in place and precaution measures are taken.
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An operational approach to the execution of MR examinations in patients with CIED. Radiol Med 2020; 125:1311-1321. [PMID: 32367321 DOI: 10.1007/s11547-020-01206-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
In the context of the increasing spread of cardiac active implantable heart devices (CIEDs) in the population and of the wide diagnostic/therapeutic utility of magnetic resonance (MRI) examinations, the goal of this paper is to provide the experience of the Santa Maria Nuova Hospital of the USL Tuscany Center in Florence and to report an organizational proposal to perform, in the hospital settings, MRI examinations on patients carrying CIED. This report is intended to show the operational choices of a Radiology Department which organizes this activity in accordance with the new Italian regulatory framework in the field of safety of MR sites (Ministero della Salute in Decreto Ministeriale 10 agosto 2018 Determinazione degli standard di sicurezza e impiego per le apparecchiature a risonanza magnetica, 2018).
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Rahsepar AA, Zimmerman SL, Hansford R, Guttman MA, Castro V, McVeigh D, Kirsch JE, Halperin HR, Nazarian S. The Relationship between MRI Radiofrequency Energy and Function of Nonconditional Implanted Cardiac Devices: A Prospective Evaluation. Radiology 2020; 295:307-313. [PMID: 32125255 PMCID: PMC7193917 DOI: 10.1148/radiol.2020191132] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022]
Abstract
Background The risks associated with MRI in individuals who have implanted cardiac devices are thought to arise from the interaction between the implanted device and static, gradient, and radiofrequency magnetic fields. Purpose To determine the relationship between the peak whole-body averaged specific absorption rate (SAR) and change in magnetic field per unit time (dB/dt), maximum specific energy dose, imaging region, and implanted cardiac device characteristics and their function in patients undergoing MRI. Materials and Methods This prospective observational cohort study was conducted from October 16, 2003, to January 22, 2015 (https://ClinicalTrials.gov, NCT01130896). Any individual with an implanted cardiac device who was referred for MRI was included. Clinical MRI protocols without SAR restriction were used. Exclusion criteria were newly implanted leads, abandoned or epicardial leads, and dependence on a pacemaker with an implantable cardioverter defibrillator without asynchronous pacing capability. For each MRI pulse sequence, the calculated whole-body values for SAR, dB/dt, and scan duration were collected. Atrial and ventricular sensing, lead impedance, and capture threshold were evaluated before and immediately after (within 10 minutes) completion of each MRI examination. Generalized estimating equations with Gaussian family, identity link, and an exchangeable working correlation matrix were used for statistical analysis. Results A total of 2028 MRI examinations were performed in 1464 study participants with 2755 device leads (mean age, 67 years ± 15 [standard deviation]; 930 men [64%]). There was no evidence of an association between radiofrequency energy deposition, dB/dt, or scan duration and changes in device parameters. Thoracic MRI was associated with decreased battery voltage immediately after MRI (β = -0.008 V, P < .001). Additionally, right ventricular (RV) lead length was associated with decreased RV sensing (β = -0.012 mV, P = .05) and reduced RV capture threshold (β = -0.002 V, P < .01) immediately after MRI. Conclusion There was no evidence of an association between MRI parameters that characterize patient exposure to radiofrequency energy and changes in device and lead parameters immediately after MRI. Nevertheless, device interrogation before and after MRI remains mandatory due to the potential for device reset and changes in lead or generator parameters. © RSNA, 2020 See also the editorial by Shellock in this issue.
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Affiliation(s)
- Amir Ali Rahsepar
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Stefan L. Zimmerman
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Rozann Hansford
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Michael A. Guttman
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Valeria Castro
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Diana McVeigh
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - John E. Kirsch
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Henry R. Halperin
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Saman Nazarian
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
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192
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Re: Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists. Clin Radiol 2020; 75:391-393. [DOI: 10.1016/j.crad.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
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193
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Salum E, Turner S, Syeda A, Singh SM. Discussions on Implantable Cardioverter-Defibrillator Deactivation in Patients Receiving Radiation Therapy: A Missed Opportunity. Can J Cardiol 2020; 37:347-349. [PMID: 32810469 DOI: 10.1016/j.cjca.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/22/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022] Open
Abstract
Established guidelines discuss end-of-life care in patients with implantable cardioverter-defibrillators (ICDs). It is not known how frequently these discussions take place in patients who have ICDs and are receiving active treatment for cancer. Chart review from a large regional cardiac and cancer center from 2005 to 2019 highlighted that discussions on ICD deactivation were infrequent (28% of patients). Receipt of a palliative care consultation increased the likelihood of patients having discussions on ICD deactivation during this time. Collaboration with palliative care teams may facilitate discussions on ICD deactivation during this opportune time.
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Affiliation(s)
- Erik Salum
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Suzette Turner
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ambreen Syeda
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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194
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Cardiac Magnetic Resonance Imaging (MRI) in Children is Safe with Most Pacemaker Systems, Including Those with Epicardial Leads. Pediatr Cardiol 2020; 41:801-808. [PMID: 32166409 DOI: 10.1007/s00246-020-02316-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) of patients with pacemakers remains concerning because of possible magnetic field effects on the device. Many pacemaker models are labeled as non-conditional, or contraindicated for MRI, or do not have any specific safety guidelines listed. This study describes our experience with pacemaker function and adverse events in pediatric and young adult patients after clinically indicated MRI scanning at 1.5 Tesla (T). We hypothesized that generator battery voltage, pacemaker lead threshold, and lead impedance would not be altered by MRI. This was a retrospective review of Children's Wisconsin clinical MRI data for all patients with pacemakers scanned between January 1, 2010 and March 31, 2018. Pacemakers were interrogated by the Electrophysiology Team before and immediately after MRI and at outpatient follow up. Twenty-one patients underwent forty-four MRI scans. No significant immediate changes were seen in any pacemaker parameter for any manufacturer/model/lead at the time of MRI. At first clinical follow up post MRI, (median 4.4 months, range 0.2-12.3), battery voltage was reduced (2.78 V pre-MRI versus 2.77 V at follow up, p = 0.02), but there were no other significant changes. No adverse events were noted. Pediatric patients with pacemakers, including those with epicardial leads, can be scanned at 1.5 T safely without alteration in pacemaker function. Using appropriate precautions, pediatric patients with pacemakers can be imaged with MRI.
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195
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Shellock FG. MRI and Patients with Non-MRI-conditional Cardiac Devices: Further Evidence of Safety. Radiology 2020; 295:314-315. [PMID: 32129708 DOI: 10.1148/radiol.2020200217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frank G Shellock
- From the Department of Radiology and Medicine, University of Southern California, Keck School of Medicine, 7751 Veragua Dr, Playa Del Rey, CA 90293
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196
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Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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197
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Pavlović N, Đula K, Kuharić I, Brusich S, Velagić V, Jurišić Z, Bakotić Z, Anić A, Pezo Nikolić B, Radeljić V, Čubranić Z, Zeljković I, Zadravec D, Manola Š. MANAGEMENT OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES UNDERGOING MAGNETIC RESONANCE IMAGING - PROPOSAL FOR UNIFIED HOSPITAL PROTOCOL: CROATIAN WORKING GROUP ON ARRHYTHMIAS AND CARDIAC PACING. Acta Clin Croat 2020; 59:119-125. [PMID: 32724282 PMCID: PMC7382882 DOI: 10.20471/acc.2020.59.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.
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Affiliation(s)
- Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Kristijan Đula
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Kuharić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Sandro Brusich
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vedran Velagić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zrinka Jurišić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zoran Bakotić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ante Anić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Borka Pezo Nikolić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zlatko Čubranić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Zeljković
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Dijana Zadravec
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
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198
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Gimenez De Lorenzo R, Navarra R, Marinelli D, Adorante N, Giancaterino S, Di Carlo C, Di Biase S, Rosa C, Falco MD. Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation. Radiol Med 2020; 125:561-568. [PMID: 32067164 DOI: 10.1007/s11547-020-01154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Left ventricular assist device (LVAD) is considered a standard care for patients with advanced heart failure. The aim of this work was to study in vitro the effects of direct exposure of the Jarvik 2000 LVAD to 10-MV photon beams. METHODS Jarvik 2000 pump was immersed in a siliconized box filled with deionized water. A 30 × 30 × 15 cm RW3 slabs were added forth and back to the box. A treatment plan consisting of a single direct 10 × 10 cm2 field size beam was used to deliver 1000 MU at the center of the pump. During irradiation, the external Flow Maker controller and the lithium battery were positioned away from the beam. Pump parameter data (included voltage, current and frequency) were measured, recorded and analyzed for changes in pump function among baseline, pre-irradiation, during irradiation, post-irradiation and after 6 months. The whole session lasted 6 months. The Mann-Whitney U test was used to compare the repeated measurements. X-ray radiation attenuation was also studied. RESULTS The parameters investigated remained stable over the 6 months; that is, no pump stops, alarms, events, operational changes or abnormalities during the discharge rate of the connected power sources, were encountered, confirmed by the Mann-Whitney U test applied to all sessions (p > 0.1). The measured X-ray attenuation differed from the calculated one by TPS by 34%. CONCLUSION The Jarvik 2000 resulted stable under direct X-ray beam of 10-MV energy. Its strong attenuation, however, can affect dose deposition in the pump in TPS, and it must be taken into account.
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Affiliation(s)
- Ramon Gimenez De Lorenzo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Riccardo Navarra
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.,Department of Neuroimaging and Cognitive Science, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Daniele Marinelli
- Department of Cardiac Surgery, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Nico Adorante
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Stefano Giancaterino
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Saide Di Biase
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Consuelo Rosa
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.
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199
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Soto DM. Current guidelines for MRI safety in patients with cardiovascular implantable electronic devices. Nursing 2020; 50:24-29. [PMID: 31904617 DOI: 10.1097/01.nurse.0000651612.85237.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Historically, MRI was contraindicated in patients with cardiovascular implantable electronic devices because the devices' metallic components made this imaging study unsafe. Advances over the last decade have now made MRI safe for many of these patients. This article examines the risks of MRI technology for this patient population and reviews recent guidelines from the Heart Rhythm Society.
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Affiliation(s)
- Desiree M Soto
- Desiree M. Soto is the electrophysiology nurse coordinator at the Jefferson Heart Institute in Philadelphia, Pa
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Munawar DA, Chan JEZ, Emami M, Kadhim K, Khokhar K, O’Shea C, Iwai S, Pitman B, Linz D, Munawar M, Roberts-Thomson K, Young GD, Mahajan R, Sanders P, Lau DH. Magnetic resonance imaging in non-conditional pacemakers and implantable cardioverter-defibrillators: a systematic review and meta-analysis. Europace 2020; 22:288-298. [DOI: 10.1093/europace/euz343] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/30/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
There is growing evidence that magnetic resonance imaging (MRI) scanning in patients with non-conditional cardiac implantable electronic devices (CIEDs) can be performed safely. Here, we aim to assess the safety of MRI in patients with non-conditional CIEDs.
Methods and results
English scientific literature was searched using PubMed/Embase/CINAHL with keywords of ‘magnetic resonance imaging’, ‘pacemaker’, ‘implantable defibrillator’, and ‘cardiac resynchronization therapy’. Studies assessing outcomes of adverse events or significant changes in CIED parameters after MRI scanning in patients with non-conditional CIEDs were included. References were excluded if the MRI conditionality of the CIEDs was undisclosed; number of patients enrolled was <10; or studies were case reports/series. 35 cohort studies with a total of 5625 patients and 7196 MRI scans (0.5–3 T) in non-conditional CIEDs were included. The overall incidence of lead failure, electrical reset, arrhythmia, inappropriate pacing and symptoms related to pocket heating, or torque ranged between 0% and 1.43%. Increase in pacing lead threshold >0.5 V and impedance >50Ω was seen in 1.1% [95% confidence interval (CI) 0.7–1.8%] and 4.8% (95% CI 3.3–6.4%) respectively. The incidence of reduction in P- and R-wave sensing by >50% was 1.5% (95% CI 0.6–2.9%) and 0.4% (95% CI 0.06–1.1%), respectively. Battery voltage reduction of >0.04 V was reported in 2.2% (95% CI 0.2–6.1%).
Conclusion
This meta-analysis affirms the safety of MR imaging in non-conditional CIEDs with no death or implantable cardioverter-defibrillator shocks and extremely low incidence of lead or device-related complications.
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Affiliation(s)
- Dian A Munawar
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Joel E Z Chan
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Mehrdad Emami
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Kadhim Kadhim
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Kashif Khokhar
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Catherine O’Shea
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Shinsuke Iwai
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Bradley Pitman
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Dominik Linz
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Muhammad Munawar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Kurt Roberts-Thomson
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Rajiv Mahajan
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, University of Adelaide, 1 Port Road, Adelaide SA 5000, Australia
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