201
|
Zeppenfeld K. Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy. JACC Clin Electrophysiol 2018; 4:1123-1140. [PMID: 30236385 DOI: 10.1016/j.jacep.2018.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/06/2023]
Abstract
Catheter ablation is being increasingly performed as adjunctive treatment to prevent recurrent implantable cardioverter-defibrillator therapies in patients with nonischemic cardiomyopathy and ventricular tachycardia (VT). In the context of VT ablation, nonischemic cardiomyopathy usually refers to dilated cardiomyopathy (DCM) as one morphological phenotype. Over the past decades, progress has been made to better characterize distinct subtypes and to differentiate between causes of DCM, which has important practical and prognostic implications. The goal of this review is to summarize available data on VT ablation in patients with DCM and, more specifically, review procedural and outcome data in specific etiologies and substrate location. It will focus on our current understanding of nonischemic scars, as well as the value of multimodal imaging, image integration, and electroanatomic mapping for substrate identification, procedural planning, and ablation. In addition, recent findings from whole human heart histology of patients with DCM and VT and their potential implications for imaging and mapping will be discussed.
Collapse
Affiliation(s)
- Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
202
|
|
203
|
Sramko M, Hoogendoorn JC, Glashan CA, Zeppenfeld K. Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease. Europace 2018; 21:383-403. [DOI: 10.1093/europace/euy150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marek Sramko
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jarieke C Hoogendoorn
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Claire A Glashan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| |
Collapse
|
204
|
Gniadek-Olejniczak K, Makowski K, Olszewski A, Tomczykiewicz K, Krawczyk A, Mróz J. State-of-the-art approach towards magnetic resonance imaging of the nervous system structures in patients with cardiac implantable electronic devices. Neurol Neurochir Pol 2018; 52:652-656. [PMID: 30061002 DOI: 10.1016/j.pjnns.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/25/2018] [Accepted: 07/10/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION MRI generated forces are the source of potential complications in patients with cardiac implantable electronic devices (CIED). The technological progress, and growing clinical evidence concerning the operation of the contemporary MR non-conditional CIEDs during MRI, have started to significantly change our every-day clinical practice. Nevertheless, a lot of patients who could have an MRI performed safely, still have been refused the examination. STATE-OF-THE-ART In many clinical situations, an MRI examination in a patient with a CIED is reasonable, and is linked to a negligible risk of complications if performed under strict precautions. The MagnaSave Registry that evaluated the influence of nonthoracic MRI on the function of MR non-conditional CIEDs, and numerous studies involving thoracic and non-thoracic MRIs in patients with legacy CIEDs, have confirmed the feasibility and safety of such examinations. In this article, practical tips aimed towards improving the safety of MRI in MR conditional and non-conditional CIED patients are largely based on the very recently released (2017) HRS expert consensus statement. CLINICAL IMPLICATIONS Clinical data emphasize the necessity of making the MRI more accessible to CIED patients, also in the case of MR non-conditional systems or when the thorax MR imaging is clinically reasonable. This goal should be achieved by increasing the number of centers complying with respective recommendations and applying protocols that would guarantee the highest safety level. FUTURE DIRECTIONS Further studies are warranted to assess safety issues related to the main current contraindication to MRI, i.e., the presence of abandoned leads.
Collapse
Affiliation(s)
| | - Karol Makowski
- Department of Cardiology, Military Institute of Medicine, Warsaw, Poland
| | - Adam Olszewski
- Department of Rehabilitation with a Neurological Subunit, Military Institute of Medicine, Warsaw, Poland
| | - Kazimierz Tomczykiewicz
- Academy of Physical Education, Faculty of Tourism and Chair of Health Science of the Academy of Physical Education, Warsaw, Poland
| | - Andrzej Krawczyk
- Teleinformatic Division, Military Institute of Medicine, Warsaw, Poland
| | - Józef Mróz
- Department of Rehabilitation with a Neurological Subunit, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
205
|
Kapa S, Davis DR, Park DS, Steinberg BA, Viswanathan MN, Tzou W, Madhavan M, Ceresnak SR, Wang PJ. Year in Review in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2018; 11:e006648. [PMID: 30012874 DOI: 10.1161/circep.118.006648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Suraj Kapa
- Mayo Clinic, Rochester, MN (S.K., M.M.).
| | - Darryl R Davis
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Canada (D.R.D.)
| | | | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City (B.A.S.)
| | - Mohan N Viswanathan
- Cardiovascular Medicine, School of Medicine, Stanford University, CA (M.N.V., P.J.W.)
| | - Wendy Tzou
- University of Colorado School of Medicine, Aurora (W.T.)
| | | | - Scott R Ceresnak
- Stanford University-Lucile Packard Children's Hospital, CA (S.R.C.)
| | - Paul J Wang
- Cardiovascular Medicine, School of Medicine, Stanford University, CA (M.N.V., P.J.W.)
| |
Collapse
|
206
|
Blessberger H, Kiblboeck D, Reiter C, Lambert T, Kellermair J, Schmit P, Fellner F, Lichtenauer M, Kypta A, Steinwender C, Kammler J. Monocenter Investigation Micra® MRI study (MIMICRY): feasibility study of the magnetic resonance imaging compatibility of a leadless pacemaker system. Europace 2018; 21:137-141. [DOI: 10.1093/europace/euy143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/27/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hermann Blessberger
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Daniel Kiblboeck
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Thomas Lambert
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Joerg Kellermair
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Pierre Schmit
- Central Radiology Institute, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Franz Fellner
- Central Radiology Institute, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
- Medical Faculty of the Friedrich Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Kypta
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Juergen Kammler
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| |
Collapse
|
207
|
Kiblboeck D, Reiter C, Kammler J, Schmit P, Blessberger H, Kellermair J, Fellner F, Steinwender C. Artefacts in 1.5 Tesla and 3 Tesla cardiovascular magnetic resonance imaging in patients with leadless cardiac pacemakers. J Cardiovasc Magn Reson 2018; 20:47. [PMID: 29973228 PMCID: PMC6033226 DOI: 10.1186/s12968-018-0469-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging. The aim of this prospective, single-center, observational study was to evaluate artefacts on cardiovascular magnetic resonance (CMR) images in patients with LCP. METHODS Fifteen patients with Micra™ LCP, implanted at least 6 weeks prior to CMR scan, were enrolled and underwent either 1.5 Tesla or 3 Tesla CMR imaging. Artefacts were categorized into grade 1 (excellent image quality), grade 2 (good), grade 3 (poor) and grade 4 (non-diagnostic) for each myocardial segment. One patient was excluded because of an incomplete CMR investigation due to claustrophobia. RESULTS LCP caused an arc-shaped artefact (0.99 ± 0.16 cm2) at the right ventricular (RV) apex. Of 224 analyzed myocardial segments of the left ventricle (LV) 158 (70.5%) were affected by grade 1, 27 (12.1%) by grade 2, 17 (7.6%) by grade 3 and 22 (9.8%) by grade 4 artefacts. The artefact burden of grade 3 and 4 artefacts was significantly higher in the 3 Tesla group (3 Tesla vs 1.5 Tesla: 3.7 ± 1.6 vs 1.9 ± 1.4 myocardial segments per patient, p = 0.03). A high artefact burden was particularly observed in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV and in the mid and apical segments of the RV. Quantification of LV function and assessment of valves were feasible in all patients. We did not observe any clinical or device-related adverse events. CONCLUSION CMR imaging in patients with LCP is feasible with excellent to good image quality in the majority of LV segments. The artefact burden is comparable small allowing an accurate evaluation of LV function, cardiac structures and valves. However, artefacts in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV due to the LCP may impair or even exclude diagnostic evaluation of these segments. Artefacts on CMR images may be reduced by the use of 1.5 Tesla CMR scanners.
Collapse
Affiliation(s)
- Daniel Kiblboeck
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Juergen Kammler
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Pierre Schmit
- Department of Radiology, Kepler University Hospital Linz, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Franz Fellner
- Department of Radiology, Kepler University Hospital Linz, Linz, Austria
- Medical Faculty of the Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|
208
|
Shah AD, Morris MA, Hirsh DS, Warnock M, Huang Y, Mollerus M, Merchant FM, Patel AM, Delurgio DB, Patel AU, Hoskins MH, El Chami MF, Leon AR, Langberg JJ, Lloyd MS. Magnetic resonance imaging safety in nonconditional pacemaker and defibrillator recipients: A meta-analysis and systematic review. Heart Rhythm 2018; 15:1001-1008. [DOI: 10.1016/j.hrthm.2018.02.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/29/2022]
|
209
|
Cay S, Ozcan F, Ozeke O, Topaloglu S, Aras D. Defibrillation failure: Considerations. J Arrhythm 2018; 34:333-334. [PMID: 29951158 PMCID: PMC6009999 DOI: 10.1002/joa3.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Serkan Cay
- Division of Arrhythmia and Electrophysiology Department of Cardiology University of Health Sciences Yuksek Ihtisas Heart-Education and Research Hospital Ankara Turkey
| | - Firat Ozcan
- Division of Arrhythmia and Electrophysiology Department of Cardiology University of Health Sciences Yuksek Ihtisas Heart-Education and Research Hospital Ankara Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology Department of Cardiology University of Health Sciences Yuksek Ihtisas Heart-Education and Research Hospital Ankara Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology Department of Cardiology University of Health Sciences Yuksek Ihtisas Heart-Education and Research Hospital Ankara Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology Department of Cardiology University of Health Sciences Yuksek Ihtisas Heart-Education and Research Hospital Ankara Turkey
| |
Collapse
|
210
|
Post-Implant Management of Sacral Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
211
|
Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
Collapse
Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
212
|
Patients With Cardiac Rhythm Management Devices: How True Is the Need for Magnetic Resonance Imaging? JACC Clin Electrophysiol 2018; 3:1003-1005. [PMID: 29759704 DOI: 10.1016/j.jacep.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 11/20/2022]
|
213
|
Rahsepar AA, Collins JD, Knight BP, Hong K, Carr JC, Kim D. Wideband LGE MRI permits unobstructed viewing of myocardial scarring in a patient with an MR-conditional subcutaneous implantable cardioverter-defibrillator. Clin Imaging 2018; 50:294-296. [PMID: 29747127 DOI: 10.1016/j.clinimag.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 10/17/2022]
Abstract
A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative device for prevention of sudden cardiac death, without any leads within the heart. Patients implanted with any type of ICD may need catheter ablation of ventricular tachycardia (VT) to reduce the overall arrhythmia burden (e.g., recurrent monomorphic VT) and lower the incidence of painful shocks induced by the device. Late gadolinium enhancement (LGE) MRI is a useful pre-test for guiding VT ablation, because it can be used to map myocardial scar and produce better outcomes. Growing evidence suggests that MRI can be performed with manageable risks on patients with a cardiac implantable electronic device (CIED). Nonetheless, the diagnostic yield of cardiac MRI is still low because of severe image artifacts, regardless of MR-conditional or non-MR conditional labeling. Image artifacts in the heart induced by an S-ICD is expected to be larger than the artifacts induced by a transvenous ICD, because the former is twice as large in size and implanted closer to the heart. This is the first reported case of successful wideband LGE MRI in a patient implanted with an MR-conditional S-ICD. A 37-year-old man with ischemic cardiomyopathy was referred for a cardiac MRI at 1.5 T ten months after S-ICD implantation, in order to rule out constrictive pericarditis. Clinical standard LGE MRI produced severe image artifacts, rendering it useless. In contrast, wideband LGE MRI provided unobstructed viewing of myocardial scarring. This case illustrates the usefulness of wideband LGE MRI for assessment of myocardial scarring in a patient with an MR-conditional S-ICD.
Collapse
Affiliation(s)
- Amir Ali Rahsepar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - KyungPyo Hong
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
214
|
Nyotowidjojo IS, Skinner K, Shah AS, Bisla J, Singh S, Khoubyari R, Ott P, Kalb B, Indik JH. Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:589-596. [DOI: 10.1111/pace.13340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/05/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kristina Skinner
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Aakash S. Shah
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Jaskinwal Bisla
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Satinder Singh
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Rostam Khoubyari
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Peter Ott
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Bobby Kalb
- Department of Medical Imaging; University of Arizona College of Medicine; Tucson AZ USA
| | - Julia H. Indik
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| |
Collapse
|
215
|
Shulman RM, Hunt B. Cardiac implanted electronic devices and MRI safety in 2018-the state of play. Eur Radiol 2018; 28:4062-4065. [PMID: 29713781 DOI: 10.1007/s00330-018-5396-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
Traditionally, the presence of cardiac implanted electronic devices (CIEDs) was a contra-indication to magnetic resonance (MR) imaging. Professional groups from around the world are releasing updated guidelines for the imaging of MR-conditional and legacy CIEDs, reflecting increasing evidence that this can be performed safely when strict protocols are followed. KEY POINTS • The presence of a pacemaker or automatic implanted cardioverter defibrillator is no longer an absolute contraindication to magnetic resonance imaging. • Strict protocols enable diagnostic quality images to be obtained with minimal risk. • Close collaboration among radiologists, cardiologists and device manufacturer representatives is required.
Collapse
Affiliation(s)
- Ryan Mark Shulman
- Queensland X-Ray, Gold Coast Private Hospital, Southport, Queensland, Australia.
- Department of Medical Imaging, Gold Coast University Hospital, Southport, Queensland, Australia.
- Griffith University, Southport, Queensland, Australia.
| | - Ben Hunt
- Department of Cardiology and Electrophysiology, Pindara Private Hospital, Benowa, Queensland, Australia
| |
Collapse
|
216
|
Affiliation(s)
- Saman Nazarian
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | |
Collapse
|
217
|
Rego Silva J, Macau R, Oliveira Coelho H, Camelo F, Cruz P, Mateus A, Oliveira A, Oliveira C, Ramos A. Late-Onset Post-transplantation Central Nervous System Lymphoproliferative Disorder: Case Report. Transplant Proc 2018; 50:857-860. [DOI: 10.1016/j.transproceed.2018.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
218
|
Sancho-Tello de Carranza MJ, Cano Pérez Ó, Osca Asensi J, Lorente Carreño D, Pombo Jiménez M, Fidalgo Andrés ML. Selección de lo mejor del año 2017 en estimulación cardiaca: resonancia magnética en pacientes portadores de marcapasos y desfibriladores. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
219
|
Yoneyama K, Kitanaka Y, Tanaka O, Akashi YJ. Cardiovascular magnetic resonance imaging in heart failure. Expert Rev Cardiovasc Ther 2018; 16:237-248. [PMID: 29478345 DOI: 10.1080/14779072.2018.1445525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Heart failure is a complex clinical syndrome resulting from heart structural remodeling and impaired function in ejecting blood; its incidence is increasing markedly worldwide. The observed variations in the structure and function of the heart are attributable to differences in etiology of heart failure. Cardiac magnetic resonance imaging (CMR) can characterize myocardial tissue, assess myocardial viability, and help diagnose specific cardiomyopathies. The emergence of T1 mapping techniques further improves our knowledge and the clinical assessment of myocardial diffuse fibrosis. Physicians, therefore, must identify the variations using CMR to improve patient's symptoms, survival, and quality of life. Area covered: Current reports regarding CMR and the evidence for heart failure diagnosis and therapy as a potential marker of therapeutic response, including low- and high-risk patients, were reviewed. Literature search was performed using PubMed and Google Scholar for literature relevant to CMR, late gadolinium enhancement, T1 mapping, assessment of fibrosis and remodeling, coronary artery, myocardial infarction, heart failure, and its outcomes. Expert commentary: The authors review current evidence and discuss the potential ability of CMR to guide, diagnose, plan risk strategies, and treat patients with heart failure.
Collapse
Affiliation(s)
- Kihei Yoneyama
- a Division of Cardiology, Department of Internal Medicine , St. Marianna University School of Medicine , Kawasaki , Japan.,b Heart Disease Center , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Yuki Kitanaka
- c Department of Radiology , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Osamu Tanaka
- b Heart Disease Center , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Yoshihiro J Akashi
- a Division of Cardiology, Department of Internal Medicine , St. Marianna University School of Medicine , Kawasaki , Japan
| |
Collapse
|
220
|
Morris MF, Verma DR, Sheikh H, Su W, Pershad A. Outcomes after magnetic resonance imaging in patients with pacemakers and defibrillators and abandoned leads. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:685-688. [PMID: 29454532 DOI: 10.1016/j.carrev.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Michael F Morris
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Department of Radiology, Banner University Medical Center, Phoenix, United States.
| | - Divya Ratan Verma
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
| | - Hasaam Sheikh
- Department of Radiology, Banner University Medical Center, Phoenix, United States
| | - Wilber Su
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
| | - Ashish Pershad
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
| |
Collapse
|
221
|
Sancho-Tello de Carranza MJ, Cano Pérez Ó, Osca Asensi J, Lorente Carreño D, Pombo Jiménez M, Fidalgo Andrés ML. Selection of the Best of 2017 on Cardiac Pacing: Magnetic Resonance in Patients With Pacemaker and Implantable Defibrillator. ACTA ACUST UNITED AC 2018; 71:229-231. [PMID: 29433943 DOI: 10.1016/j.rec.2017.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Óscar Cano Pérez
- Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Osca Asensi
- Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Marta Pombo Jiménez
- Unidad de Estimulación Cardiaca, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | |
Collapse
|
222
|
Beltrami M, Palazzuoli A, Padeletti L, Cerbai E, Coiro S, Emdin M, Marcucci R, Morrone D, Cameli M, Savino K, Pedrinelli R, Ambrosio G. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction. Int J Clin Pract 2018; 72. [PMID: 29283475 DOI: 10.1111/ijcp.13050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/29/2017] [Indexed: 12/28/2022] Open
Abstract
AIM Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. METHODS The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. RESULTS In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. CONCLUSION Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies.
Collapse
Affiliation(s)
- Matteo Beltrami
- Cardio-Thoracic and Vascular Department, University of Florence, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | | | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Florence, Italy
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic diseases, University of Florence, Florence, Italy
| | - Doralisa Morrone
- Surgery, medicine, molecular and critical area Department, Cardiovascular disease Section 2, Pisa, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Ketty Savino
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Roberto Pedrinelli
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| |
Collapse
|
223
|
Holzhauser L, Imamura T, Nayak HM, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Patel A, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation-An Underrecognized Problem. J Card Fail 2018; 24:101-108. [PMID: 29325797 PMCID: PMC5945281 DOI: 10.1016/j.cardfail.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. METHODS We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). RESULTS A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. CONCLUSION RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
Collapse
Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hemal M Nayak
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nitasha Sarswat
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sara Kalantari
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Onsager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
| |
Collapse
|
224
|
Marra MP, Basso C. Cardiac magnetic resonance imaging in patients with a nonconditional cardiac implantable device: Good-quality images besides safety are essential. Heart Rhythm 2018; 15:226-227. [DOI: 10.1016/j.hrthm.2017.11.022] [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: 11/13/2017] [Indexed: 10/18/2022]
|
225
|
Korutz AW, Russell EJ, Hijaz TA, Collins JD, Knight BP, Nemeth AJ. Reply. AJNR Am J Neuroradiol 2018; 39:E37. [PMID: 29074630 DOI: 10.3174/ajnr.a5467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - B P Knight
- Department of Medicine, Division of Cardiology
| | - A J Nemeth
- Departments of Radiology and Neurology Northwestern University Feinberg School of Medicine Chicago, Illinois
| |
Collapse
|
226
|
Antonucci MU, Spampinato MV, Ritenour ER. Economic Considerations in MR Imaging of Patients with Cardiac Devices. AJNR Am J Neuroradiol 2018; 39:E36. [PMID: 29074631 DOI: 10.3174/ajnr.a5450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M U Antonucci
- Department of Radiology and Radiological Science Medical University of South Carolina Charleston, South Carolina
| | - M V Spampinato
- Department of Radiology and Radiological Science Medical University of South Carolina Charleston, South Carolina
| | - E R Ritenour
- Department of Radiology and Radiological Science Medical University of South Carolina Charleston, South Carolina
| |
Collapse
|
227
|
An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator. Eur Radiol 2018; 28:2406-2416. [PMID: 29318430 DOI: 10.1007/s00330-017-5098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). METHODS We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). RESULTS 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three-12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. CONCLUSIONS A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. KEY POINTS • Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers. • No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers. • Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic. • All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic. • Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.
Collapse
|
228
|
Linde C, Steffel J. The year in cardiology 2017: arrhythmias and cardiac devices. Eur Heart J 2018; 39:434-441. [PMID: 29300864 DOI: 10.1093/eurheartj/ehx765] [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: 09/25/2017] [Accepted: 12/11/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Jan Steffel
- Division of Electrophysiology and Pacing, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| |
Collapse
|
229
|
Padmanabhan D, Jondal ML, Hodge DO, Mehta RA, Acker NG, Dalzell CM, Kapa S, Asirvatham SJ, Cha YM, Felmlee JP, Watson RE, Friedman PA. Mortality After Magnetic Resonance Imaging of the Brain in Patients With Cardiovascular Implantable Devices. Circ Arrhythm Electrophysiol 2018; 11:e005480. [DOI: 10.1161/circep.117.005480] [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: 05/23/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Deepak Padmanabhan
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Mary L. Jondal
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - David O. Hodge
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Ramila A. Mehta
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Nancy G. Acker
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Connie M. Dalzell
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Suraj Kapa
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Yong-Mei Cha
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Joel P. Felmlee
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Robert E. Watson
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Paul A. Friedman
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| |
Collapse
|
230
|
Tang PT, Do DH, Li A, Boyle NG. Team Management of the Ventricular Tachycardia Patient. Arrhythm Electrophysiol Rev 2018; 7:238-246. [PMID: 30588311 DOI: 10.15420/aer.2018.37.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/03/2018] [Indexed: 12/16/2022] Open
Abstract
Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. In addition, these patients often have multiple comorbidities. While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients.
Collapse
Affiliation(s)
- Pok Tin Tang
- Cardiology Department, John Radcliffe Hospital Oxford, UK
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, California, USA
| | - Anthony Li
- Cardiology Department, St George's University Hospital London, UK
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, California, USA
| |
Collapse
|
231
|
Nazarian S, Hansford R, Rahsepar AA, Weltin V, McVeigh D, Gucuk Ipek E, Kwan A, Berger RD, Calkins H, Lardo AC, Kraut MA, Kamel IR, Zimmerman SL, Halperin HR. Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. N Engl J Med 2017; 377:2555-2564. [PMID: 29281579 PMCID: PMC5894885 DOI: 10.1056/nejmoa1604267] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed "MRI-conditional" devices). METHODS We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter-defibrillator (42%) that was not considered to be MRI-conditional (termed a "legacy" device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters). RESULTS No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient's device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming. CONCLUSIONS We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter-defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896 .).
Collapse
Affiliation(s)
- Saman Nazarian
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Rozann Hansford
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Amir A Rahsepar
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Valeria Weltin
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Diana McVeigh
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Esra Gucuk Ipek
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Alan Kwan
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Ronald D Berger
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Hugh Calkins
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Albert C Lardo
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Michael A Kraut
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Ihab R Kamel
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Stefan L Zimmerman
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Henry R Halperin
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| |
Collapse
|
232
|
Cavallo JJ, Zhang Y, Staib LH, Lampert R, Weinreb JC. Disparities in Care Among Patients With Cardiac Implantable Electronic Devices Undergoing MRI. J Am Coll Radiol 2017; 14:1566-1571. [DOI: 10.1016/j.jacr.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022]
|
233
|
Biffi M, Menardi E, Narducci ML, Ammendola E, Messano L, Giofrè F, Baiocchi C, Saporito D, Lissoni F, Bertini M, Pierantozzi A, Zingarini G, Malacrida M, Ziacchi M. Manufacturer change and risk of system-related complications after implantable cardioverter defibrillator replacement. J Cardiovasc Med (Hagerstown) 2017; 18:968-975. [DOI: 10.2459/jcm.0000000000000572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
234
|
Pacemaker malfunction risks within the electromagnetically rich hospital environment. Hellenic J Cardiol 2017; 59:247-248. [PMID: 29154816 DOI: 10.1016/j.hjc.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 11/23/2022] Open
|
235
|
Mason S, Osborn JS, Dhar R, Tonkin A, Ethington JD, Le V, Benuzillo J, Lappe DL, Knowlton KU, Bunch TJ, Anderson JL. Real world MRI experience with nonconditional and conditional cardiac rhythm devices after MagnaSafe. J Cardiovasc Electrophysiol 2017; 28:1468-1474. [DOI: 10.1111/jce.13351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Steve Mason
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | | | - Ritesh Dhar
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | - Allison Tonkin
- Intermountain Medical Center; Department of Radiology; Salt Lake City UT USA
| | | | - Viet Le
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | - Jose Benuzillo
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | - Donald L. Lappe
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
- Department of Internal Medicine; University of Utah School of Medicine; Salt Lake City UT USA
| | - T. Jared Bunch
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
| | - Jeffrey L. Anderson
- Intermountain Medical Center Heart Institute; Salt Lake City UT USA
- Department of Internal Medicine; University of Utah School of Medicine; Salt Lake City UT USA
| |
Collapse
|
236
|
Gillam MH, Inacio MCS, Pratt NL, Shakib S, Roughead EE. Magnetic Resonance Imaging in People With Cardiac Implantable Electronic Devices: A Population Based Cohort Study. Heart Lung Circ 2017; 27:748-751. [PMID: 29037957 DOI: 10.1016/j.hlc.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022]
Abstract
Magnetic resonance imaging (MRI) is a widely used diagnostic tool with great benefits but has been considered contraindicated in people with cardiac implantable electronic devices (CIED). We investigated the occurrence of MRI in people with CIEDs and associated adverse events in a national cohort. Of 17,848 people included, 56 (0.3%) had at least one MRI; 16 of 16,102 (0.1%) with MRI non-compatible CIEDs and 40 of 1746 (2%) with MRI compatible CIEDs. Following MRI exposure, hospitalisations for potential serious adverse events were rare.
Collapse
Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Maria C S Inacio
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
237
|
Hilbert S, Jahnke C, Loebe S, Oebel S, Weber A, Spampinato R, Richter S, Doering M, Bollmann A, Sommer P, Hindricks G, Paetsch I. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality. Eur Heart J Cardiovasc Imaging 2017; 19:1051-1061. [DOI: 10.1093/ehjci/jex243] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/23/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Hilbert
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Cosima Jahnke
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Susanne Loebe
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sabrina Oebel
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Alexander Weber
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ricardo Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sergio Richter
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Michael Doering
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ingo Paetsch
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| |
Collapse
|
238
|
Padmanabhan D, Kella DK, Mehta R, Kapa S, Deshmukh A, Mulpuru S, Jaffe AS, Felmlee JP, Jondal ML, Dalzell CM, Asirvatham SJ, Cha YM, Watson RE, Friedman PA. Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads. Heart Rhythm 2017; 15:228-233. [PMID: 29045806 DOI: 10.1016/j.hrthm.2017.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND During magnetic resonance imaging (MRI), abandoned leads may act as antennae that result in tissue heating and arrhythmia induction. OBJECTIVE The purpose of this study was to assess the safety of MRI in patients with abandoned leads, with the addition of cardiac troponin T (cTnT) assessment to screen for myocardial damage. METHODS We reviewed our prospectively collected database of patients with cardiovascular implantable electronic devices (CIEDs) undergoing MRI between 2008 and 2017 at Mayo Clinic, Rochester, MN, and selected patients who had abandoned leads. We compared the adverse events in this population with an age, sex, and site of MRI-matched cohort of patients selected from this database. We evaluated paired (before/after) cTnT values using MRI in these patients. RESULTS Of 952 patients, 80 (8.4%) underwent 97 MRI scans with CIEDs in situ with 90 abandoned leads in place during the scans. The median age was 66 years (interquartile range 22.3 years) 66.1 years (interquartile range, Q1,Q3: 53.6, 75.9) with 66.3% (53 patients) men. There was no clinical or electrical evidence of CIED dysfunction, arrhythmias, or pain. Paired samples for the measurement of cTnT values were available in 40 patients undergoing 44 MRI examinations. The mean difference between the pre- and postimaging values was -0.002 ± 0.006 ng/mL (interquartile range 0). There was no difference after adjustment for total number of leads per patient and total number of implantable cardioverter-defibrillator coils. CONCLUSION There was no evidence of myocardial injury as measured by paired cTnT. The risk of MRI with abandoned leads appears low, suggesting a favorable risk-benefit profile in patients with CIEDs and abandoned leads who are considered for MRI.
Collapse
Affiliation(s)
| | - Danesh K Kella
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Ramila Mehta
- Division of Biomedical Statistics and Informatics, Rochester, Minnesota
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | | | - Siva Mulpuru
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mary L Jondal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | | | | |
Collapse
|
239
|
Do DH, Eyvazian V, Bayoneta AJ, Hu P, Finn JP, Bradfield JS, Shivkumar K, Boyle NG. Cardiac magnetic resonance imaging using wideband sequences in patients with nonconditional cardiac implanted electronic devices. Heart Rhythm 2017; 15:218-225. [PMID: 29017930 DOI: 10.1016/j.hrthm.2017.10.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been performed safely in patients without MRI-conditional cardiac implantable electronic devices (CIEDs), but experience specifically with cardiac magnetic resonance imaging (CMR) is limited in this patient population. OBJECTIVE Evaluate the safety of CMR in non-MRI-conditional CIEDs and the interpretability of images using wideband sequences. METHODS We performed 114 consecutive CMR studies in 111 patients (mean age 59 ± 14 years, with 12 pacemakers, 73 implantable cardioverter defibrillators, 29 biventricular defibrillators) using a wideband pulse sequence for late gadolinium enhancement (LGE) imaging. A standardized protocol for device management and patient monitoring was followed. Patients were evaluated for major clinical adverse events and device parameter changes immediately after CMR and at clinical follow-up. RESULTS In total, 111 CMR studies were completed successfully. There were no patient deaths, new arrhythmias, immediate generator or lead failures, electrical resets, or pacing capture failures in dependent patients. Right atrial, right ventricular, and left ventricular lead impedances were significantly lower post CMR, with median differences -7 Ω (interquartile range [IQR] -20 to 0 Ω; P < .0001), 0 Ω (IQR -19 to 0 Ω; P = .0001), and -10 Ω (IQR -30 to 0 Ω; P = .023), respectively. These changes persisted through the follow-up period, with median differences -18.5 Ω (IQR -41 to -66 Ω; P = .007), -19 Ω (IQR -44 to -7 Ω; P = .006), and -30 Ω (IQR -130 to 0 Ω; P = .003), respectively. Ninety-seven studies (87%) had no artifact limiting interpretation. CONCLUSIONS CMR can be performed safely in non-MRI-conditional CIEDs using a standardized protocol. Use of a wideband pulse sequence for LGE imaging yields a high rate of studies unaffected by artifact.
Collapse
Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Vaughn Eyvazian
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Aileen J Bayoneta
- UCLA Department of Radiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Peng Hu
- UCLA Department of Radiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - J Paul Finn
- UCLA Department of Radiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
| |
Collapse
|
240
|
Andrews CM, Srinivasan NT, Rosmini S, Bulluck H, Orini M, Jenkins S, Pantazis A, McKenna WJ, Moon JC, Lambiase PD, Rudy Y. Response by Andrews et al to Letter Regarding Article, “Electrical and Structural Substrate of Arrhythmogenic Right Ventricular Cardiomyopathy Determined Using Noninvasive Electrocardiographic Imaging and Late Gadolinium Magnetic Resonance Imaging”. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005768. [DOI: 10.1161/circep.117.005768] [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: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher M. Andrews
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Neil T. Srinivasan
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Stefania Rosmini
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Heerajnarain Bulluck
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Michele Orini
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Sharon Jenkins
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Antonis Pantazis
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - William J. McKenna
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - James C. Moon
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Pier D. Lambiase
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| | - Yoram Rudy
- From the Cardiac Bioelectricity and Arrhythmia Center and Department of Biomedical Engineering (C.M.A., Y.R.) and Cardiovascular Division, Department of Medicine, MO (Y.R.), Washington University in St. Louis, MO; Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.O., S.J., A.P., W.J.M., P.D.L.); and Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., S.R., H.B., M.O., S.J., A.P., W.J.M., J
| |
Collapse
|
241
|
2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 743] [Impact Index Per Article: 106.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
|
242
|
Quirouet A, Bhattacharyya PK, Dielubanza EJ, Gill BC, Jones SE, Goldman HB. Sacral Neuromodulation Device Heating During Lumbar and Pelvic Magnetic Resonance Imaging—a Phantom Study. Urology 2017. [DOI: 10.1016/j.urology.2017.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
243
|
Kalb B, Indik JH, Ott P, Martin DR. MRI of patients with implanted cardiac devices. J Magn Reson Imaging 2017; 47:595-603. [PMID: 28776823 DOI: 10.1002/jmri.25824] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022] Open
Abstract
Cardiac implanted electronic devices (CIEDs) have historically been regarded as a contraindication for performing magnetic resonance imaging (MRI), limiting the availability of this exam for large numbers of patients who may have otherwise benefited from the unique diagnostic capabilities of MRI. Interactions between CIEDs and the magnetic field associated with MRI systems have been documented, and include potential effects on CIED function, lead heating, and force/torque on the generator. Several device manufacturers have developed "MR-Conditional" CIEDs with specific hardware and software design changes to optimize the device for the MR environment. However, a substantial body of evidence has been accumulating that suggests that MRI may be safely performed in patients with either conditional or nonconditional CIEDs. Institutional policies and procedures, including preexam screening and assessment by skilled electrophysiology personnel and intraexam monitoring, allow MRI to be safely performed in CIED patients, as evidenced by at least two, large multicenter prospective studies and multiple smaller, single-institution studies. Cross-departmental collaboration and a robust safety infrastructure at sites that perform MRI should allow for the safe imaging of CIED patients who have a clinical indication for the study, regardless of the conditionality status of the device. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:595-603.
Collapse
Affiliation(s)
- Bobby Kalb
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Julia H Indik
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Peter Ott
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Diego R Martin
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| |
Collapse
|
244
|
The need for MR conditional devices: a sand castle at the seashore? Heart Rhythm 2017; 14:1145-1146. [DOI: 10.1016/j.hrthm.2017.04.033] [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: 04/07/2017] [Indexed: 11/18/2022]
|
245
|
Strom JB, Whelan JB, Shen C, Zheng SQ, Mortele KJ, Kramer DB. Safety and utility of magnetic resonance imaging in patients with cardiac implantable electronic devices. Heart Rhythm 2017; 14:1138-1144. [PMID: 28385671 PMCID: PMC5557369 DOI: 10.1016/j.hrthm.2017.03.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Off-label magnetic resonance imaging (MRI) for patients with cardiac implantable electrical devices has been limited owing to concerns about safety and unclear diagnostic and prognostic utility. OBJECTIVE The purpose of this study was to define major and minor adverse events with off-label MRI scans. METHODS We prospectively evaluated patients with non-MRI-conditional cardiac implantable electrical devices referred for MRI scans under a strict clinical protocol. The primary safety outcome was incidence of major adverse events (loss of pacing, inappropriate shock or antitachycardia pacing, need for system revision, or death) or minor adverse events (inappropriate pacing, arrhythmias, power-on-reset events, heating at the generator site, or changes in device parameters at baseline or at 6 months). RESULTS A total of 189 MRI scans were performed in 123 patients (63.1% [78] men; median age 70 ± 18.5 years; 56.9% [70] patients with implantable cardioverter-defibrillators; 33.3% [41] pacemaker-dependent patients) predominantly for brain or spinal conditions. A minority of scans (22.7% [43]) were performed for urgent or emergent indications. Major adverse events were rare: 1 patient with loss of pacing, no deaths, or system revisions (overall rate 0.5%; 95% confidence interval 0.01-2.91). Minor adverse events were similarly rare (overall rate 1.6%; 95% confidence interval 0.3-4.6). Nearly all studies (98.4% [186]) were interpretable, while 75.1% [142] were determined to change management according to the prespecified criteria. No clinically significant changes were observed in device parameters acutely after MRI or at 6 months as compared with baseline across all patient and device categories. CONCLUSION Off-label MRI scans performed under a strict protocol demonstrated excellent short- and medium-term safety while providing interpretable imaging that frequently influenced clinical care.
Collapse
Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jill B Whelan
- Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Koenraad J Mortele
- Department of Radiology, Divisions of Abdominal Imaging and Body MRI, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
246
|
Ghoshhajra BB, Fifer MA. Thick Walls, Thin Data. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006889. [DOI: 10.1161/circimaging.117.006889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
247
|
Alan S, Vaidya V, Asirvatham S. Highlights from Heart Rhythm Society 2017: Innovations in Electrophysiology Patient Management, and Beyond. J Innov Card Rhythm Manag 2017; 8:2820-2823. [PMID: 32494467 PMCID: PMC7252800 DOI: 10.19102/icrm.2017.080804] [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: 12/02/2022] Open
|
248
|
Celentano E, Caccavo V, Santamaria M, Baiocchi C, Melissano D, Pisanò E, Gallo P, Polcino A, Arena G, Patanè S, Senatore G, Licciardello G, Padeletti L, Vado A, Giorgi D, Pecora D, Stella P, Anaclerio M, Guastaferro C, Giovannini T, Giacopelli D, Gargaro A, Maglia G. Access to magnetic resonance imaging of patients with magnetic resonance-conditional pacemaker and implantable cardioverter-defibrillator systems: results from the Really ProMRI study. Europace 2017; 20:1001-1009. [DOI: 10.1093/europace/eux118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/06/2017] [Indexed: 11/14/2022] Open
|
249
|
Magnetic resonance imaging in patients with cardiac implantable electronic devices: a single-center prospective study. J Interv Card Electrophysiol 2017; 50:95-104. [DOI: 10.1007/s10840-017-0262-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
|
250
|
Korutz AW, Obajuluwa A, Lester MS, McComb EN, Hijaz TA, Collins JD, Dandamudi S, Knight BP, Nemeth AJ. Pacemakers in MRI for the Neuroradiologist. AJNR Am J Neuroradiol 2017; 38:2222-2230. [PMID: 28705821 DOI: 10.3174/ajnr.a5314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac implantable electronic devices are frequently encountered in clinical practice in patients being screened for MR imaging examinations. Traditionally, the presence of these devices has been considered a contraindication to undergoing MR imaging. Growing evidence suggests that most of these patients can safely undergo an MR imaging examination if certain conditions are met. This document will review the relevant cardiac implantable electronic devices encountered in practice today, the background physics/technical factors related to scanning these devices, the multidisciplinary screening protocol used at our institution for scanning patients with implantable cardiac devices, and our experience in safely performing these examinations since 2010.
Collapse
Affiliation(s)
- A W Korutz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - A Obajuluwa
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - M S Lester
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - E N McComb
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - T A Hijaz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - J D Collins
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - S Dandamudi
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - B P Knight
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - A J Nemeth
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.).,Neurology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|