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Bhuva AN, Moralee R, Moon JC, Manisty CH. Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. Eur Radiol 2019; 30:1378-1384. [PMID: 31776746 PMCID: PMC7033076 DOI: 10.1007/s00330-019-06449-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.
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Affiliation(s)
- A N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute for Cardiovascular Science, University College London, London, UK.
| | - R Moralee
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - J C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
| | - C H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
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152
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Padmanabhan D, Kella DK, Deshmukh AJ, Mulpuru SK, Mehta RA, Dalzell CM, Olson NE, Felmlee JP, Jondal ML, Asirvatham SJ, Watson RE, Cha YM, Friedman PA. Safety of thoracic magnetic resonance imaging for patients with pacemakers and defibrillators. Heart Rhythm 2019; 16:1645-1651. [DOI: 10.1016/j.hrthm.2019.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 12/26/2022]
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153
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Vuorinen AM, Pakarinen S, Jaakkola I, Holmström M, Kivistö S, Kaasalainen T. Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population. Acta Radiol 2019; 60:1414-1421. [PMID: 30781967 DOI: 10.1177/0284185119830288] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Magnetic resonance imaging (MRI) in patients with cardiac pacing devices has become available despite previously being considered absolutely contraindicated. However, most institutional safety protocols have included several limitations on patient selection, leaving MRI unavailable for many patients. Purpose To evaluate the first 1000 MRI examinations conducted on patients with cardiac pacing devices at Helsinki University Hospital for any potential safety hazards and also to evaluate the long-term functionality of the safety protocol in “real-life” clinical practice. Material and Methods A total of 1000 clinically indicated MRI scans were performed with a 1.5-T MRI scanner according to the safety protocol. The following information was collected from the electronic medical record (EMR): patients’ date of birth; sex; pacing device generator model; date of MRI scan; date of the latest pacing device generator implantation; and the body region scanned. The EMR of these patients was checked and especially searched for any pacing device related safety hazards or adverse outcomes during or after the MRI scan. Results Only one potentially dangerous adverse event was noted in our study group. In addition, patients with abandoned leads, temporary pacing devices, and newly implanted pacing device generators were scanned successfully and safely. Conclusion MRI scans can be performed safely in patients with cardiac pacing devices if the dedicated safety protocol is followed.
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Affiliation(s)
- Aino-Maija Vuorinen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Pakarinen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Jaakkola
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Kivistö
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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154
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Grewal SS, Gorny KR, Favazza CP, Watson RE, Kaufmann TJ, Van Gompel JJ. Safety of Laser Interstitial Thermal Therapy in Patients With Pacemakers. Oper Neurosurg (Hagerstown) 2019; 15:E69-E72. [PMID: 29444267 DOI: 10.1093/ons/opx292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Laser interstitial thermal therapy (LiTT) has increasingly been used as a treatment option for medically refractory epilepsy, tumors, and radiation necrosis. The use of LiTT requires intraoperative magnetic resonance (MR) thermography. This can become an issue in patients with other implanted therapeutic devices such as pacemakers and vagal nerve stimulators due to concerns regarding increases in the specific absorption rate (SAR). This is a technical case report demonstrating a successfully and safely performed LiTT in a 1.5-T magnetic resonance imaging (MRI) in a patient with a pacemaker for mesial temporal sclerosis. CLINICAL PRESENTATION An 83-yr-old gentleman who had an implanted cardiac pacemaker presented with medically intractable epilepsy and was confirmed to have mesial temporal sclerosis on imaging. Video electroencephalography demonstrated concordant ipsilateral seizures and semiology. He underwent LiTT for ablation of the mesial temporal lobe. This was performed with the below described protocol with a cardiology nurse monitoring the patient's cardiac condition and a physicist monitoring SAR, and MR imaging quality without any adverse events. CONCLUSION This study reports on a protocol of cardiac and MR SAR to safely perform MR-guided LiTT in the setting of traditional pacemakers in patients who are not pacemaker dependent.
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Affiliation(s)
- Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
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155
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Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned CIED. Neurosurg Rev 2019; 43:1539-1546. [PMID: 31624965 DOI: 10.1007/s10143-019-01149-6] [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: 02/14/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned cardiac implantable electrical devices (CIEDs) remains controversial. While a growing number of studies have shown safe employment in select patients under strict protocols, there is an increasing clinical need for further off-label investigations. To assess the feasibility and utility of brain MRI in neurological and neurosurgical patients with non-MRI-conditioned CIEDs using off-label protocol. We retrospectively evaluated 126 patients with non-MRI-conditioned CIEDs referred to our hospital between 2014 to 2018 for MRI under an IRB-approved protocol. A total of 126 off-label brain MRI scans were performed. The mean age was 67.5 ± 13.0. Seventy percent of scans were performed on female patients. Indications for MRI are neurosurgical (45.2%), neurological (51.6%), and others (3.2%). MRI utilization for tumor cases was highest for tumor cases (68.3%), but employment was valuable for vascular (12.7%), deep brain stimulators (3.2%), and other cases (15.9%). In the tumor category, (37.2%) of the scans were performed for initial diagnosis and pre-surgical planning, (47.7%) for post-intervention evaluation/surveillance, (15.1%) for stereotactic radiosurgery treatment (CyberKnife). No clinical complications were encountered. No functional device complications of the CIED were identified during and after the MRI in 96.9% of the studies. A 49.6% of the off-label brain MRI scans performed led to a clinically significant decision and/or intervention for the patients. A 42.9% of obtained MRI studies did not change the plan of care. A 7.9% of post-scan decision-making data was not available. We demonstrate that off-label brain MRI scans performed on select patients under a strict protocol is feasible, safe, and relevant. Almost 50% of scans provided critical information resulting in clinical intervention of the patients.
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156
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Delfino JG, Krainak DM, Flesher SA, Miller DL. MRI-related FDA adverse event reports: A 10-yr review. Med Phys 2019; 46:5562-5571. [PMID: 31419320 DOI: 10.1002/mp.13768] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To provide an overview of the types of adverse events reported to the US Food and Drug Administration (US FDA) for magnetic resonance (MR) systems over a 10-yr period. METHODS Two reviewers independently reviewed adverse events reported to FDA for MR systems from 1 January 2008 to 31 December 2017 and manually categorized events into eight event types. Thermal events were further subcategorized by probable cause. Objects that became projectiles were also categorized. RESULTS FDA received 1568 adverse event reports for MR systems between 1 January 2008 and 31 December 2017. This analysis included 1548 reports. Thermal events were the most commonly reported serious injury (59% of analyzed reports). Mechanical events - defined as slips, falls, crush injuries, broken bones, and cuts; musculoskeletal injuries from lifting or movement of the device - (11%), projectile events (9%), and acoustic events (6%) were also observed. CONCLUSIONS Adverse events related to MR systems consistent with the known hazards of the MR environment continue to be reported to FDA. Increased awareness of the types of adverse events occurring for MR imaging systems is important for prevention.
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Affiliation(s)
- Jana G Delfino
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Daniel M Krainak
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Stephanie A Flesher
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Donald L Miller
- Office of In Vitro Devices and Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
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157
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Bhuva AN, Feuchter P, Hawkins A, Cash L, Boubertakh R, Evanson J, Schilling R, Lowe M, Moon JC, Manisty CH. MRI for patients with cardiac implantable electronic devices: simplifying complexity with a 'one-stop' service model. BMJ Qual Saf 2019; 28:853-858. [PMID: 30760606 PMCID: PMC6837254 DOI: 10.1136/bmjqs-2018-009079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist. AIM To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs). METHODS Patients requested a 'one-stop' service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this 'one-stop' service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed. RESULTS 215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation. CONCLUSION Implementation of a 'one-stop' service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.
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Affiliation(s)
- Anish N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Patricia Feuchter
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Angela Hawkins
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Lizette Cash
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Redha Boubertakh
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Jane Evanson
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Richard Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Martin Lowe
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Charlotte H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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158
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Jabehdar Maralani P, Schieda N, Hecht EM, Litt H, Hindman N, Heyn C, Davenport MS, Zaharchuk G, Hess CP, Weinreb J. MRI safety and devices: An update and expert consensus. J Magn Reson Imaging 2019; 51:657-674. [PMID: 31566852 DOI: 10.1002/jmri.26909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.
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Affiliation(s)
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University, New York, New York, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Hindman
- Department of Radiology, New York University, New York, New York, USA
| | - Chinthaka Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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159
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Bayouth JE, Low DA, Zaidi H. MRI-linac systems will replace conventional IGRT systems within 15 years. Med Phys 2019; 46:3753-3756. [PMID: 31199516 DOI: 10.1002/mp.13657] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 05/06/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- John E Bayouth
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
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160
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Metal Artifact Reduction in Cardiovascular MRI for Accurate Myocardial Scar Assessment in Patients With Cardiac Implantable Electronic Devices. AJR Am J Roentgenol 2019; 213:555-561. [DOI: 10.2214/ajr.19.21187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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161
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Safety and efficiency of low-field magnetic resonance imaging in patients with cardiac rhythm management devices. Eur J Radiol 2019; 118:96-100. [PMID: 31439265 DOI: 10.1016/j.ejrad.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/18/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Low-field magnetic resonance imaging (MRI), i.e. MRI with a static magnetic field strength <0.5 T, has been reported to be safe in patients with pacemakers, however there are no data about the safety of low-field MRI in patients with implantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy (CRT). We aimed to investigate the safety and diagnostic efficiency of routine low-field MRI in patients with different devices for cardiac rhythm management (i.e. pacemakers and ICD, including devices with CRT). METHOD MRI scans of 446 regions of interest were evaluated with field strength of 0.2 T in 338 patients (62% male; age at MRI scan 76.1 ± 9.2 years; time since device implantation 4.1 ± 3.2 years) with cardiac rhythm management devices (298 pacemakers, 25 ICD, 8 CRT-ICD, and 7 CRT pacemakers). This analysis included 62 pacemaker-dependent patients (18.3%), 52 patients with 1.5-Tesla-MR conditional pacemakers (15.4%) and 13 patients with abandoned leads (3.9%). RESULTS Except for one examination, which was interrupted because of recurrent severe nausea, all MRI scans could be analyzed efficiently. No induction of arrhythmia or inhibition of pacemaker function occurred. Compared to the device interrogation before MRI, there were no significant changes in battery voltage, pacing capture threshold, sensing of intrinsic ECG, lead impedance, as well as shock impedance in ICD devices after completed examination. CONCLUSIONS Low-field MRI examinations (0.2 T) were efficient and safe regarding clinical and technical complications in patients with devices for cardiac rhythm management, even in case of pacemaker-dependency or the presence of abandoned leads.
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162
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Cunqueiro A, Lipton ML, Dym RJ, Jain VR, Sterman J, Scheinfeld MH. Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists. Clin Radiol 2019; 74:912-917. [PMID: 31431253 DOI: 10.1016/j.crad.2019.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Pacemakers and implantable cardioverter defibrillators are commonly encountered in clinical practice, and entails special consideration when magnetic resonance imaging (MRI) is required. It is estimated that 50-75% of patients with cardiac implantable electronic devices (CIED) will have an indication for MRI during their lifetime. Radiologists may want to recommend MRI or may be consulted about the need to perform MRI in a patient with a CIED, at which point they may need to approve or at least provide guidance as to whether MRI may be performed safely. Even in situations where final clearance will not be provided by the radiologist, he or she can provide valuable information by reviewing radiographs and determining (a) whether a device is MRI-conditional and MRI may ultimately be permitted, (b) is not MRI-conditional and MRI using the standard workflow will therefore not be approved, or (c) when additional information will clearly be required. CIED identification and verification of leads can be accomplished through review of the medical record and/or evaluation of a chest radiograph. In patients with MRI-conditional CIEDs (as well as with legacy CIEDs in those institutions that perform MRI of these patients), specific imaging protocols must be adhered to in order to prevent death or injury to the patient or damage to the device. In this update, we provide details regarding the above topics and provide an algorithm for integrating this information into a clinical workflow to efficiently triage patients with CIEDs who are being considered for MRI.
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Affiliation(s)
- A Cunqueiro
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M L Lipton
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neuroscience, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R J Dym
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - V R Jain
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Sterman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M H Scheinfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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163
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Okada DR, Wu KC. Applications of Cardiac MR Imaging in Electrophysiology. Magn Reson Imaging Clin N Am 2019; 27:465-473. [PMID: 31279450 DOI: 10.1016/j.mric.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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164
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Radiation Therapy Workflow and Dosimetric Analysis from a Phase 1/2 Trial of Noninvasive Cardiac Radioablation for Ventricular Tachycardia. Int J Radiat Oncol Biol Phys 2019; 104:1114-1123. [DOI: 10.1016/j.ijrobp.2019.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
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165
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Sutton R, Benditt DG. Viewpoint: Cardiac implantable electronic devices and magnetic resonance compatibility: was it really necessary? J Interv Card Electrophysiol 2019; 55:125-127. [DOI: 10.1007/s10840-019-00526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
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166
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Yamada T. Computed tomography continues to be the preferred tomographic imaging technology for patients with cardiac implantable electronic devices despite a potential risk of electrical interference by irradiation. J Nucl Cardiol 2019; 26:1166-1168. [PMID: 29511927 DOI: 10.1007/s12350-018-1246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, Birmingham, AL, 35294-0019, USA.
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167
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MILAN DAVID, KLEIN HELMUT, GIMBEL JROD, KNILANS TIMOTHY, MIRRO MICHAEL, ZIRILLE FRANCIS. Considering the Need to Expand the Indications for Wearable Defibrillator Therapy. J Innov Card Rhythm Manag 2019; 10:3751-3760. [PMID: 32494421 PMCID: PMC7252810 DOI: 10.19102/icrm.2019.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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168
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Martinez JA, Ennis DB. MRI of Patients with Cardiac Implantable Electronic Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12:27. [PMID: 36117853 PMCID: PMC9477432 DOI: 10.1007/s12410-019-9502-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review The purpose of this review is to clarify the risks associated with MRI exams for patients with cardiac implantable electronic devices (CIEDs) and to provide information regarding the MRI examination protocol for patients with CIEDs. Recent Findings Several prospective studies evaluated the feasibility of MRI exams for patients with CIEDs and reported no adverse events. These studies suggest that by following a specific MRI examination protocol and monitoring both CIED parameters and the patient's symptoms, an MRI exam can be performed by appropriately trained personnel with an acceptable benefit-to-risk ratio. Summary Both MR unsafe and MR conditional CIEDs are commercially available, but there are no MR safe CIEDs. The potential risks faced by patients with CIEDs during an MRI exam are always present and warrant careful monitoring. Three magnetic fields in the MRI scanner interact with the device in ways that can damage the CIED or harm the patient. Due to safety concerns and out of an abundance of caution, the majority of MRI exams for patients with CIEDs are currently denied. However, when following a specific MRI exam protocol, these risks can be mitigated.
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Affiliation(s)
- Jessica A. Martinez
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
- The Richard M. Lucas Center for Imaging, Radiological Sciences Lab, 1201 Welch Road, Stanford, CA 94305, USA
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Nelson T, Garg P, Clayton RH, Lee J. The Role of Cardiac MRI in the Management of Ventricular Arrhythmias in Ischaemic and Non-ischaemic Dilated Cardiomyopathy. Arrhythm Electrophysiol Rev 2019; 8:191-201. [PMID: 31463057 PMCID: PMC6702467 DOI: 10.15420/aer.2019.5.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Ventricular tachycardia (VT) and VF account for the majority of sudden cardiac deaths worldwide. Treatments for VT/VF include anti-arrhythmic drugs, ICDs and catheter ablation, but these treatments vary in effectiveness and carry substantial risks and/or expense. Current methods of selecting patients for ICD implantation are imprecise and fail to identify some at-risk patients, while leading to others being overtreated. In this article, the authors discuss the current role and future direction of cardiac MRI (CMRI) in refining diagnosis and personalising ventricular arrhythmia management. The capability of CMRI with gadolinium contrast delayed-enhancement patterns and, more recently, T1 mapping to determine the aetiology of patients presenting with heart failure is well established. Although CMRI imaging in patients with ICDs can be challenging, recent technical developments have started to overcome this. CMRI can contribute to risk stratification, with precise and reproducible assessment of ejection fraction, quantification of scar and 'border zone' volumes, and other indices. Detailed tissue characterisation has begun to enable creation of personalised computer models to predict an individual patient's arrhythmia risk. When patients require VT ablation, a substrate-based approach is frequently employed as haemodynamic instability may limit electrophysiological activation mapping. Beyond accurate localisation of substrate, CMRI could be used to predict the location of re-entrant circuits within the scar to guide ablation.
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Affiliation(s)
- Tom Nelson
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Pankaj Garg
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Richard H Clayton
- INSIGNEO Institute for In-Silico Medicine, University of SheffieldSheffield, UK
- Department of Computer Science, University of SheffieldSheffield, UK
| | - Justin Lee
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
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170
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Kramer DB, Kesselheim AS. Coverage of Magnetic Resonance Imaging for Patients With Cardiac Devices: Improving the Coverage With Evidence Development Program. JAMA Cardiol 2019; 2:711-712. [PMID: 28492917 DOI: 10.1001/jamacardio.2017.1674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel B Kramer
- Harvard Medical School, Boston, Massachusetts2The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Aaron S Kesselheim
- Harvard Medical School, Boston, Massachusetts3Program On Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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171
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Koshy A, Witte K. Uses and potential for cardiac magnetic resonance imaging in patients with cardiac resynchronisation pacemakers. Expert Rev Med Devices 2019; 16:445-450. [DOI: 10.1080/17434440.2019.1618706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Aaron Koshy
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
| | - Klaus Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
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172
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Seewöster T, Löbe S, Hilbert S, Bollmann A, Sommer P, Lindemann F, Bacevičius J, Schöne K, Richter S, Döring M, Paetsch I, Hindricks G, Jahnke C. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: best practice and real-world experience. Europace 2019; 21:1220-1228. [DOI: 10.1093/europace/euz112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/31/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Cardiovascular magnetic resonance (CMR) imaging has long been a contraindication for patients with a cardiac implantable electronic device (CIED). Recent studies support the feasibility and safety for non-thoracic magnetic resonance imaging, but data for CMR are sparse. The aim of the current study was to determine the safety in patients with magnetic resonance (MR)-conditional or non-MR-conditional CIED and to develop a best practice approach.
Methods and results
All patients with a CIED undergoing CMR imaging (1.5 T) between April 2014 and April 2017 were included in the study. Devices were programmed according to the standardized protocol directly before and after the CMR examination. Follow-up interrogation was performed 6 months after CMR examination. Results were compared with a large, reference cohort of CIED patients not undergoing any MR examination. A total of 200 consecutive patients with a CIED (non-MR-conditional, n = 103) were included in the study. Directly after CMR imaging, one device failure (0.5%, battery status = end of service) was noted necessitating premature generator replacement. In three patients (2%) of pacemaker/implantable cardioverter-defibrillator (ICD) carriers a sustained ventricular tachycardia (VT) occurred during CMR imaging. Ten ICD showed a decrease in battery capacity immediately after CMR. Overall, the reference cohort showed comparable changes of CIED function during follow-up.
Conclusion
With adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Susanne Löbe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69A, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstraße 11, Bad Oeynhausen, Germany
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Justinas Bacevičius
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Katharina Schöne
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Michael Döring
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69A, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
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173
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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, 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. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
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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174
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CMR and CT of the Patient With Cardiac Devices. JACC Cardiovasc Imaging 2019; 12:890-903. [DOI: 10.1016/j.jcmg.2018.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
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175
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Reiter T, Bauer WR. [Magnetic resonance imaging and active cardiac implants]. Herzschrittmacherther Elektrophysiol 2019; 30:177-182. [PMID: 31025097 DOI: 10.1007/s00399-019-0622-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 11/29/2022]
Abstract
The combination of magnetic resonance imaging (MRI) and active cardiac implants, such as pacemakers and implantable cardioverter defibrillators (ICD) has been a challenge for electrophysiologists and imaging for many years. Diagnostic and therapeutic possibilities on the one hand and technical hazards on the other hand highlight the need for improvements and algorithms that enable a safe approach to these challenges. The advent of so-called MRI conditional implants provides safe procedures for at least some of the patients with an implant and the need for MRI. Recently published data encourage clinicians not to completely excluded an imaging modality as promising as MRI in clinically urgent cases in the presence of conventional implants. The interdisciplinary consensus paper of the German Society of Cardiology and the German Society of Radiology provides recommendations for these situations. This review article discusses these recommendations and provides an overview of the most recent publications with a focus on the long-term course of device parameters.
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Affiliation(s)
- T Reiter
- Kardiale MRT und Klinische Elektrophysiologie, Medizinische Klinik und Poliklinik I des Universitätsklinikums Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - W R Bauer
- Kardiale MRT und Klinische Elektrophysiologie, Medizinische Klinik und Poliklinik I des Universitätsklinikums Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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176
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Update on MR imaging of the pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1483-1497. [PMID: 31030315 DOI: 10.1007/s10554-019-01603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
Magnetic resonance imaging (MRI) plays an increasingly important role in the non-invasive evaluation of the pulmonary vasculature. MR angiographic (MRA) techniques provide morphological information, while MR perfusion techniques provide functional information of the pulmonary vasculature. Contrast-enhanced MRA can be performed at high spatial resolution using 3D T1-weighted spoiled gradient echo sequence or at high temporal resolution using time-resolved techniques. Non-contrast MRA can be performed using 3D steady state free precession, double inversion fast spin echo, time of flight or phase contrast sequences. MR perfusion can be done using dynamic contrast-enhanced technique or using non-contrast techniques such as arterial spin labelling and time-resolved imaging of lungs during free breathing with Fourier decomposition analysis. MRI is used in the evaluation of acute and chronic pulmonary embolism, pulmonary hypertension and other vascular abnormalities, congenital anomalies and neoplasms. In this article, we review the different MR techniques used in the evaluation of pulmonary vasculature and its clinical applications.
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177
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Singh A, Kawaji K, Goyal N, Nazir NT, Beaser A, O'Keefe-Baker V, Addetia K, Tung R, Hu P, Mor-Avi V, Patel AR. Feasibility of Cardiac Magnetic Resonance Wideband Protocol in Patients With Implantable Cardioverter Defibrillators and Its Utility for Defining Scar. Am J Cardiol 2019; 123:1329-1335. [PMID: 30739658 DOI: 10.1016/j.amjcard.2019.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 02/03/2023]
Abstract
Implantable cardioverter defibrillators (ICDs) have been a relative contraindication to cardiovascular magnetic resonance imaging. Although cardiovascular magnetic resonance provides valuable information regarding scar in patients with ventricular arrhythmias or cardiomyopathy, ICDs in these patients frequently cause artifacts hindering accurate interpretation of both cine and late gadolinium enhancement (LGE) images. We sought to quantify the frequency and severity of artifact on LGE images and assess whether a modified wideband LGE protocol could improve the diagnostic yield of scar identification in agreement with invasive electroanatomic mapping (EAM). Forty-nine patients with ICDs and ventricular tachycardia (VT) or cardiomyopathy underwent CMR (Philips 1.5T), including standard and wideband LGE imaging. A safety algorithm was followed throughout the protocol. Standard and wideband LGE short-axis images were graded using an artifact score on a per-slice basis. LGE on wideband images was compared with EAM in 27 of 49 patients who underwent VT ablation. There were no adverse patient- or device-related events. With standard LGE imaging, 84% of patients demonstrated some degree of hyperenhancement artifact, which persisted in 22% on wideband LGE but with much less extent. Wideband LGE imaging resulted in an increase from 48% to 94% diagnostic-quality slices, with a significant reduction in artifact score, and correlated with EAM in 21 of 27 patients (78%). In conclusion, assessment of standard LGE is markedly limited by artifact in patients with ICD. The use of wideband LGE significantly improves image quality and can accurately localize myocardial scar before VT ablation.
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178
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Safety and Image Quality of 1.5-T Endorectal Coil Multiparametric MRI of the Prostate or Prostatectomy Fossa for Patients With Pacemaker or Implantable Cardioverter-Defibrillator. AJR Am J Roentgenol 2019; 212:815-822. [DOI: 10.2214/ajr.18.20266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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179
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Antonucci MU. Final Coverage Determination for Magnetic Resonance Imaging in Patients With Cardiac Devices. JAMA Neurol 2019; 76:369-370. [DOI: 10.1001/jamaneurol.2018.4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael U. Antonucci
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
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180
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Cardiac pacemakers: a basic review of the history and current technology. J Vet Cardiol 2019; 22:40-50. [PMID: 30792165 DOI: 10.1016/j.jvc.2019.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
In the 60 years since the first human implant of a cardiac pacemaker, tremendous improvements have been made to devices themselves as well as the lead systems. Improvement in battery materials has allowed for production of smaller devices with greater longevity and a vast array of technologies allowing for communication between the device and the operator. Lead wires, typically to as the weakest part of the pacing system, have also seen a metamorphosis as improvements in conductor materials and hybrid insulation have been shown to improve reliability. With the recent development of leadless pacing systems, the downfalls of implantable leads can be avoided. These improvements have allowed a more widespread use of cardiac pacing in veterinary applications since the first reported canine implant in 1967.
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181
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Wilson SR, Shinde S, Appleby I, Boscoe M, Conway D, Dryden C, Ferguson K, Gedroyc W, Kinsella SM, Nathanson MH, Thorne J, White M, Wright E. Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019. Anaesthesia 2019; 74:638-650. [DOI: 10.1111/anae.14578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/02/2023]
Affiliation(s)
- S. R. Wilson
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (Co‐Chair)
| | - S. Shinde
- Department of Anaesthesia North Bristol NHS Trust BristolUK and Vice President, Association of Anaesthetists (Co‐Chair)
| | - I. Appleby
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland
| | - M. Boscoe
- Royal College of Anaesthetists LondonUK and Society of Anaesthetists in Radiology
| | - D. Conway
- Department of Anaesthesia Chelsea and Westminster Hospital LondonUK and Trainee Committee, Association of Anaesthetists
| | - C. Dryden
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital LiverpoolUK and Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - K. Ferguson
- Department of Anaesthesia Aberdeen Royal Infirmary Aberdeen UK and Association of Anaesthetists Safety Representative
| | - W. Gedroyc
- Imperial College LondonUK and Royal College of Radiologists
| | - S. M. Kinsella
- Department of Anaesthesia St Michaels Hospital BristolUK and Editor, Anaesthesia
| | - M. H. Nathanson
- Department of Anaesthesia Nottingham University Hospital NottinghamUK and Immediate Past Honorary Secretary, Association of Anaesthetists
| | - J. Thorne
- Department of Neurosurgery Salford Royal Foundation Trust SalfordUK and Society of British Neurological Surgeons
| | | | - E. Wright
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital Liverpool UK
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182
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Tang CX, Petersen SE, Sanghvi MM, Lu GM, Zhang LJ. Cardiovascular magnetic resonance imaging for amyloidosis: The state-of-the-art. Trends Cardiovasc Med 2019; 29:83-94. [DOI: 10.1016/j.tcm.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/01/2023]
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183
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Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices. Int J Cardiol 2019; 279:72-78. [PMID: 30642645 DOI: 10.1016/j.ijcard.2019.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/17/2018] [Accepted: 01/02/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. METHODS 136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. RESULTS CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. CONCLUSION The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.
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184
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Han D, Kang SH, Cho Y, Oh IY. Experiences of magnetic resonance imaging scanning in patients with pacemakers or implantable cardioverter-defibrillators. Korean J Intern Med 2019; 34:99-107. [PMID: 29609452 PMCID: PMC6325447 DOI: 10.3904/kjim.2017.251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS Despite the U.S. Food and Drug Adminstration approving a magnetic resonance imaging (MRI)-conditional pacemaker system in 2011, many physicians remain reluctant to perform MRI scanning in patients with cardiac implantable electronic devices. Herein, we aimed to evaluate the real-world safety of MRI in these patients. METHODS This single-center retrospective study examined the interrogation data and outcomes of patients with pacemakers or implantable cardioverter defibrillators who underwent MRI. MRI interrogation data were collected pre- and post-MRI and after 1 month of follow-up; these included the lead impedance, measured P- and R-wave amplitudes, and capture threshold. We compared these results between the magnetic resonance (MR)-conditional and conventional groups. RESULTS From September 2013 to December 2015, 35 patients with cardiac implantable electronic devices underwent 43 MRI scans, with a mean follow-up of 5 months. Among these 35 patients, 14 (40%) had MR-conditional devices and 21 (60%) had conventional devices. Seven patients had high voltage devices, which were all the conventional type. There were no adverse events associated with MRI during the follow-up period, and there were no significant differences in the interrogation data changes between the conventional and MR-conditional groups. CONCLUSION This single-center retrospective study found that MRI can be performed safely in patients with pacemakers or implantable cardioverter defibrillators, regardless of the MRI support, as long as appropriate precautions are taken.
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Affiliation(s)
- Donghoon Han
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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185
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Stawiarski K, Sorajja D, Ramakrishna H. Magnetic Resonance and Computed Tomography Imaging in Patients with Cardiovascular Implantable Electronic Devices: Analysis of Expert Consensus Data and Implications for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2018; 32:2817-2822. [DOI: 10.1053/j.jvca.2018.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/11/2022]
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186
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Kramer DB, Lo B, Russo RJ. Implications of Medicare Coverage for Magnetic Resonance Imaging in Patients With Capped or Epicardial Leads. JAMA Cardiol 2018; 3:1139-1140. [DOI: 10.1001/jamacardio.2018.3820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel B. Kramer
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard Lo
- The Greenwall Foundation, New York, New York
- University of California, San Francisco
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187
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Maass AH, Hemels MEW, Allaart CP. Magnetic resonance imaging in patients with cardiac implantable electronic devices. Neth Heart J 2018; 26:584-590. [PMID: 30406601 PMCID: PMC6288036 DOI: 10.1007/s12471-018-1192-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In recent years the prevalence of implantation of a cardiac implantable electronic device (CIED) has increased due to expanding implantation indications and prolonged life expectancy. Diagnostic strategies increasingly employ magnetic resonance imaging (MRI) to aid therapeutic strategies. In earlier guidelines, MRI was contra-indicated in patients with CIEDs, mainly due to previous reports of severe complications. With the development of MRI-conditional CIEDs and recent evidence concerning non-MRI-conditional CIEDs, MRIs in CIED patients can be safely performed in many hospitals.However, there are several questions that need to be addressed. Which patients can we scan? How can the scans be performed safely? And last but not least, can cardiac MRI provide diagnostic yield in patients with CIEDs?Current European guidelines are rather outdated and vague about patient selection and practical issues. There are national guidelines on this topic but several issues need extra attention and those are addressed in this point of view. It is important to create an environment with proper patient selection without unnecessary MRI scans in CIED patients, but also without unnecessary fear of complications, preventing access to MRI in patients who can benefit from this powerful diagnostic tool.
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Affiliation(s)
- A H Maass
- Department of Cardiology, Thorax center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.,Radboud University Hospital, University of Nijmegen, Nijmegen, The Netherlands
| | - C P Allaart
- Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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188
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Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A. MRI in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 289:281-292. [DOI: 10.1148/radiol.2018180285] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Muthalaly
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Yin Ge
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Raymond Y. Kwong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Arthur Nasis
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
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189
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Mar PL, Chen G, Gandhi G, Tang ZZ, Leiserowitz A, Tripuraneni A, Kreps E, Botting L, Lakkireddy D, Granato JE, Gopinathannair R. Cost-effectiveness analysis of magnetic resonance imaging–conditional pacemaker implantation: Insights from a multicenter study and implications in the current era. Heart Rhythm 2018; 15:1690-1697. [DOI: 10.1016/j.hrthm.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 10/16/2022]
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190
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Provision of MR imaging for patients with cardiac implantable electronic devices (CIEDs): a single-center experience and national survey. Ir J Med Sci 2018; 188:999-1004. [PMID: 30368645 DOI: 10.1007/s11845-018-1922-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIEDs) were traditionally denied access to MR imaging due to safety concerns. AIMS The aim of this study was to review a single-center experience of MR imaging at 1.5T of patients with CIEDs and survey national availability of this service. METHODS Three hundred thirty-four patients with CIEDs were included in the review. Two hundred nine patients did not progress to MRI due to non MR-conditional CIEDs, retained pacing leads, recent implant insertion, and other patient factors. A record was made of CIED type, number of body parts imaged, numbers of repeat studies and complications. All devices were scanned with cardiology involvement. RESULTS One hundred twenty-five patients, 90 males, 35 females, aged 20-91 years progressed to MR imaging. Eighty-six patients had pacemakers, 15 had implantable cardioverter devices (ICDs), and 24 had implantable loop recorders (ILRs). Twenty-one patients had more than one body part scanned. Regions scanned included spine n = 82, joints n = 42, head n = 40, heart n = 8, and abdomen/pelvis n = 13. Twenty-six patients had multiple separate MR studies (range 2-6). Three complications included diaphragmatic stimulation when the device was switched to MR-conditional mode resulting in scan abandonment, device failure post-MRI requiring manufacturer reprogramming, and patient dizziness post reprogramming requiring cardiology review. One cardiac study was non-diagnostic due to artifact from a low left-sided ICD. Imaging of patients with pacemakers is available in 14 of 42 (38%) hospitals with MR units nationally. CONCLUSION MR-conditional CIEDs can be safely scanned with diagnostic quality at 1.5T using a protocol involving radiology and cardiology.
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191
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Van Nieuwenhove S, Saussez TP, Thiry S, Trefois P, Annet L, Michoux N, Lecouvet F, Tombal B. Prospective comparison of a fast 1.5-T biparametric with the 3.0-T multiparametric ESUR magnetic resonance imaging protocol as a triage test for men at risk of prostate cancer. BJU Int 2018; 123:411-420. [PMID: 30240059 DOI: 10.1111/bju.14538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare prospectively the diagnostic performance of a biparametric (T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) 1.5-T fast magnetic resonance imaging (fMRI) protocol with the standard 3.0-T multiparametric MRI (mpMRI) protocol of the European Society of Urological Imaging (ESUR) in men referred for a prostate biopsy. PATIENTS AND METHODS Ninety patients with a prostate cancer (PCa) risk of ≥10% according to the SWOP calculator 4 underwent first fMRI and then the reference mpMRI. Patients with Prostate Imaging Reporting and Data System (PI-RADS) v.2 lesions ≥3/5 on the mpMRI were scheduled for MRI/ultrasonography (US) fusion-guided prostate biopsy. Performance of fMRI was assessed using receiver-operating characteristic curve analysis and mpMRI as reference. Calculation of inter-technique agreement on PI-RADS v.2 score by Cohen's κ. RESULTS The diagnostic accuracy of fMRI shown by the lesion-based analysis was excellent: area under the curve (AUC) 0.961 (P < 0.001), sensitivity 95%, specificity 97%, positive predictive value (PPV) 99%, negative predictive value (NPV) 89%. The patient-based analysis showed an AUC for fMRI of 0.975 (P < 0.001), a sensitivity of 98%, a specificity of 97%, a PPV of 98% and an NPV of 97%. Agreement on the PI-RADS score between both protocols was found to be good (κ = 0.78 [0.57; 0.99]); fMRI missing PI-RADS 4 lesions in three patients. Biopsy results showed no cancer in two patients (two cores per nodule) and Gleason 6 cancer in one patient. There was only one false-positive fMRI, with a PI-RADS score of 4, whose biopsy was negative. CONCLUSION In the triage of men with a high risk of PCa for prostate biopsy, an f MRI protocol (1.5-T magnet, T2WI + DWI, <15 min) may safely replace the traditional ESUR 3.0-T mpMRI protocol, saving time and contrast injection.
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Affiliation(s)
- Sandy Van Nieuwenhove
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thibaud Pierre Saussez
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sarah Thiry
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Trefois
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Laurence Annet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Michoux
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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192
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[Pacemaker and MRI in clinical practice]. Herz 2018; 43:612-616. [PMID: 30280244 DOI: 10.1007/s00059-018-4750-y] [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: 10/28/2022]
Abstract
The number of cardiac pacemaker wearers is continuously increasing in Germany as well as worldwide. The probability of indications for a magnetic resonance imaging (MRI) examination during the lifetime is approximately 50-75% for every person. An MRI examination is nowadays possible for pacemaker wearers under certain conditions. Due to the technical developments during the last 10 years certain MRI-conditional pacemakers are available. The recommendations of the German and American medical specialist societies currently allow an MRI examination in patients with conventional pacemakers beyond the approval conditions (off-label use) under prespecified conditions, based on the study data. This article summarizes the information on conditions of use and reprogramming strategies as well as on the study situation for the clinical routine.
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193
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Culbertson CJ, Gold CA. Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices. JAMA Neurol 2018; 75:1173-1174. [DOI: 10.1001/jamaneurol.2018.1651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Collin J. Culbertson
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Carl A. Gold
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
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194
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Bitterman DS, Zei PC, Mak RH. Radiation Safety and Cardiovascular Implantable Electronic Devices. Int J Radiat Oncol Biol Phys 2018; 102:243-246. [PMID: 30191855 DOI: 10.1016/j.ijrobp.2018.05.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/30/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Danielle S Bitterman
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul C Zei
- Department of Cardiovascular Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
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195
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Ibrahim ESH, Runge M, Stojanovska J, Agarwal P, Ghadimi-Mahani M, Attili A, Chenevert T, den Harder C, Bogun F. Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices. World J Radiol 2018; 10:100-107. [PMID: 30310544 PMCID: PMC6177559 DOI: 10.4329/wjr.v10.i9.100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for imaging myocardial viability. An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia (VT), which allows for more accurate identification of the ablation targets. However, a large percentage of patients with VT have cardiac implantable electronic devices (CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns. Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted. Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts. These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation. In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware. The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images.
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Affiliation(s)
- El-Sayed H Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Mason Runge
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jadranka Stojanovska
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Prachi Agarwal
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | | | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Thomas Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Chiel den Harder
- Department of Medical Physics, Leiden University Medical Center, Leiden 2333ZA, The Netherlands
| | - Frank Bogun
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
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196
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Gopinathannair R, Mar PL, Gandhi G, Leiserowitz A, Tripuraneni A, Lakkireddy D, Chen G, Kreps E, Botting L, Copeland S, Firsich N, Kioussopoulos K, Granato JE. Incidence and predictors of MRI scan utilization in MRI-conditional pacemaker recipients: A multicenter experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1519-1525. [PMID: 30221783 DOI: 10.1111/pace.13503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/25/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Eric Kreps
- University of Alabama; Birmingham AL USA
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197
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Hong K, Collins JD, Knight BP, Carr JC, Lee DC, Kim D. Wideband myocardial perfusion pulse sequence for imaging patients with a cardiac implantable electronic device. Magn Reson Med 2018; 81:1219-1228. [PMID: 30229560 DOI: 10.1002/mrm.27458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To develop a wideband cardiac perfusion pulse sequence and test whether it is capable of suppressing image artifacts in patients with a cardiac implantable electronic device (CIED), while not exceeding the specific absorption rate (SAR) limit (2.0 W/kg). METHODS A wideband perfusion pulse sequence was developed by incorporating a wideband saturation pulse to achieve a good balance between saturation of magnetization and SAR. Clinical standard and wideband perfusion MRI scans were performed back-to-back in a randomized order on 16 patients with a CIED undergoing clinical cardiac MRI. Two expert readers graded the artifact intensity and extent on a segmental basis using a 5-point Likert scale, where significant artifact was defined by a composite score. The variance in myocardial signal prior to tissue-enhancement was analyzed to quantify artifact-intensity. Whole-body SAR values computed by the MR scanner were read from the DICOM header. Either a paired t-test or Wilcoxon signed-rank test was performed to compare two groups. RESULTS While the mean whole-body SAR for a single-slice wideband perfusion scan (0.38 ± 0.08W/kg) was significantly (p < 0.05) higher than for a single-slice standard perfusion scan (0.11 ± 0.03W/kg), it was 81% below 2.0 W/kg. The mean variance in myocardial signal prior to tissue-enhancement was significantly (p < 0.001) higher for standard (422.6 ± 306.6 a.u.) than wideband (107.0 ± 60.9 a.u.). Among 105 myocardial segments, standard produced 19 segments (18%) that were deemed to have significant artifacts, whereas wideband produced only 3 segments (3%). CONCLUSION A wideband perfusion pulse sequence is capable of suppressing image artifacts induced by a CIED while not exceeding SAR at 2.0 W/kg.
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Affiliation(s)
- KyungPyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley P Knight
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel C Lee
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Biomedical Engineering, Northwestern University, Evanston, IL
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198
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MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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199
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Markman TM, Halperin HR, Nazarian S. Update on MRI Safety in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 288:656-657. [DOI: 10.1148/radiol.2018180360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy M. Markman
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
| | - Henry R. Halperin
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
| | - Saman Nazarian
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
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200
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Gesu E, Colombo G, Moffat JV. Assessing the safety of magnetic resonance imaging in cardiac device carriers. Intern Emerg Med 2018; 13:933-935. [PMID: 29766404 DOI: 10.1007/s11739-018-1876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Elisa Gesu
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| | - Giorgio Colombo
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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