1
|
Dacher JN, Langguth P, Adam D, Winkler WB, Martí-Almor J, Prenner G, Trucco ME, Kol A, Xiang M, Melissano D, Fawaz H, Lau DH. Safety and performance of MR-conditional pacing systems with automated MRI mode at 1.5 and 3 Tesla. Eur Radiol 2023; 33:6948-6958. [PMID: 37195432 PMCID: PMC10189234 DOI: 10.1007/s00330-023-09650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To evaluate at 1.5 and 3 T MRI the safety and performance of trademarked ENO®, TEO®, or OTO® pacing systems with automated MRI Mode and the image quality of non-enhanced MR examinations. METHODS A total of 267 implanted patients underwent MRI examination (brain, cardiac, shoulder, cervical spine) at 1.5 (n = 126) or 3 T (n = 141). MRI-related device complications, lead electrical performances stability at 1-month post-MRI, proper functioning of the automated MRI mode and image quality were evaluated. RESULTS Freedom from MRI-related complications at 1 month post-MRI was 100% in both 1.5 and 3 T arms (both p < 0.0001). The stability of pacing capture threshold was respectively at 1.5 and 3 T (atrial:: 98.9% (p = 0.001) and 100% (p < 0.0001); ventricular: both 100% (p < 0001)). The stability of sensing was respectively at 1.5 and 3 T (atrial: 100% (p = 0.0001) and 96.9% (p = 0.01); ventricular: 100% (p < 0.0001) and 99.1% (p = 0.0001)). All devices switched automatically to the programmed asynchronous mode in the MRI environment and to initially programmed mode after the MRI exam. While all MR examinations were assessed as interpretable, artifacts deteriorated a subset of examinations including mostly cardiac and shoulder ones. CONCLUSION This study demonstrates the safety and electrical stability of ENO®, TEO®, or OTO® pacing systems at 1 month post-MRI at 1.5 and 3 T. Even if artifacts were noticed in a subset of examinations, overall interpretability was preserved. CLINICAL RELEVANCE STATEMENT ENO®, TEO®, and OTO® pacing systems switch to MR-mode when detecting magnetic field and switch back on conventional mode after MRI. Their safety and electrical stability at 1 month post MRI were shown at 1.5 and 3 T. Overall interpretability was preserved. KEY POINTS • Patients implanted with an MRI conditional cardiac pacemaker can be safely scanned under 1.5 or 3 Tesla MRI with preserved interpretability. • Electrical parameters of the MRI conditional pacing system remain stable after a 1.5 or 3 Tesla MRI scan. • The automated MRI mode enabled the automatic switch to asynchronous mode in the MRI environment and to initial settings after the MRI scan in all patients.
Collapse
Affiliation(s)
- Jean-Nicolas Dacher
- Department of Radiology, Normandie Univ, UNIROUEN INSERM U1096 and CHU Rouen, 37 Boulevard Gambetta, 76000, Rouen, France.
| | - Patrick Langguth
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Adam
- Monash Cardiac Rhythm Management Department, Monash Heart, Monash Medical Centre, Melbourne, Australia
| | - Walther-Benedikt Winkler
- Medical Department II With Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar (IMAS-UAB), Barcelona, Spain
| | - Günther Prenner
- Universitätsklinik Für Innere Medizin, Klinische Abteilung Für Kardiologie, Medizinische Universität Graz, Graz, Austria
| | - María Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Amir Kol
- Department of Cardiology, San Camillo De Lellis Hospital, ASL Rieti, Rieti, Italy
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Hanan Fawaz
- Clinical Affairs, MicroPort CRM, Clamart, France
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
2
|
Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. RADIOLOGIA 2023; 65:269-284. [PMID: 37268369 DOI: 10.1016/j.rxeng.2022.09.014] [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: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 06/04/2023]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
Collapse
Affiliation(s)
- M Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - B Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - D Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J L Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - T Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - E Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - A M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - S Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - R J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - C Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J M Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J A Hidalgo Pérez
- Servicio de Radiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - V Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - H Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
3
|
Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:183-196. [PMID: 36539182 DOI: 10.1016/j.rec.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/23/2022]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
Collapse
Affiliation(s)
- Manuel Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Beatriz Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - David Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomás Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Eliseo Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - Alicia M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Susanna Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - Rosario J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - Gorka Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcelo Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - Covadonga Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - José F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José María Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Esther Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vicente Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Hug Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
4
|
Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
5
|
Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
6
|
Deshpande S, Kella D, Padmanabhan D. MRI in patients with cardiac implantable electronic devices: A comprehensive review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:360-372. [DOI: 10.1111/pace.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Danesh Kella
- Department of Cardiology Piedmont Heart Institute Atlanta Georgia USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| |
Collapse
|
7
|
Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
8
|
Nguyen TD, Sandberg SA, Durrani AK, Mitchell KW, Keith MD, Gleva MJ, Woodard PK. The cumulative effects and clinical safety of repeat magnetic resonance imaging on an MRI-conditional pacemaker system at 1.5 tesla. Heart Rhythm O2 2020; 2:73-79. [PMID: 34113907 PMCID: PMC8183850 DOI: 10.1016/j.hroo.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background Studies have demonstrated magnetic resonance imaging (MRI) safety in the presence of MRI-conditional permanent pacemakers (PPM). However, since patients' care may require serial MRIs, it is necessary to evaluate device safety and performance after multiple scans. Objectives We evaluated safety and performance of MRI-conditional PPMs after serial MRIs over various anatomic regions performed during a multicenter, prospective, single-arm study (ProMRI). Methods ProMRI was a multiphase observational study designed to evaluate PPM performance after MRI scans. Our study evaluated PPM function in a cohort of patients who underwent multiple 1.5-T MRI scans. Selected patients underwent separate head, chest, and lumbar spine MRIs. Pacing capture threshold (PCT), lead impedance (LI), sensing amplitude, and battery capacity were collected before and after scanning. Freedom from serious adverse device effects (SADE) through 1 month post MRI served as a primary endpoint. Changes in PPM function parameters, including threshold success rate and sensing attenuation, were analyzed for statistical significance and clinical relevance. Results In 81 patients no adverse events or SADE occurred. Statistically significant changes in ventricular PCT (0.034 ± 0.15 V) immediately after, ventricular LI immediately after (-18.7 ± 44.2 Ω) and 1 month post phase B (-19.8 ± 44.9 Ω), and atrial sensing attenuation immediately after (-0.27 ± 0.92 mV) and 1 month post phase B (-0.22 ± 0.92 mV) were noted. However, these changes were not clinically relevant in degree. Conclusion These results demonstrate the safety and performance of the ProMRI PPM in patients undergoing 3 serial MRIs over various anatomic regions.
Collapse
Affiliation(s)
- Thuy D Nguyen
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Sarah A Sandberg
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri.,Brookwood Baptist Health, Birmingham, Alabama
| | - Amir K Durrani
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri.,Division of Cardiovascular Medicine, Washington Permanente, Seattle, Washington
| | - Kevin W Mitchell
- Clinical Studies Division at Biotronik, Inc, Lake Oswego, Oregon
| | - Matthew D Keith
- Clinical Studies Division at Biotronik, Inc, Lake Oswego, Oregon
| | - Marye J Gleva
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Pamela K Woodard
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| |
Collapse
|
9
|
Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. Rev Port Cardiol 2020; 40:41-52. [PMID: 33342713 DOI: 10.1016/j.repc.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/22/2022] Open
Abstract
Magnetic resonance imaging (MRI) is currently considered an essential complementary method for diagnosis in many conditions. Exponential growth in its use is expected due to the aging population and a broader spectrum of clinical indications. Growth in its use, coupled with an increasing number of pacemaker implants, implantable cardioverter-defibrillators and cardiac resynchronization therapy, has led to a frequent clinical need for this diagnostic modality in patients with cardiac implantable electronic devices (CIED). This clinical need has fueled the development of devices specifically designed and approved for use in a magnetic resonance (MR) environment under certain safety conditions (MR-conditional devices). More than a decade after the introduction of the first MR-conditional pacemaker, there are now several dozen MR-conditional devices with different safety specifications. In recent years, increasing evidence has indicated there is a low risk to MRI use in conventional (so-called non-MR-conditional) CIED patients in the right circumstances. The increasing number, as well as the greater diversity and complexity of implanted devices, justify the need to standardize procedures, by establishing institutional agreements that require close collaboration between cardiologists and radiologists. This consensus document, prepared jointly by the Portuguese Society of Cardiology and the Portuguese Society of Radiology and Nuclear Medicine, provides general guidelines for MRI in patients with CIED, ensuring the safety of patients, health professionals and equipment. In addition to briefly reviewing the potential risks of MRI in patients with CIED and major changes to MRI-conditional devices, this article provides specific recommendations on risk-benefit analysis, informed consent, scheduling, programming strategies, devices, monitoring and modification of MRI sequences. The main purpose of this document is to optimize patient safety and provide legal support to facilitate easy access by CIED patients to a potentially beneficial and irreplaceable diagnostic technique.
Collapse
Affiliation(s)
- Ana G Almeida
- Serviço de Cardiologia do Hospital Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Natália António
- Unidade de Pacing e Eletrofisiologia, Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Saraiva
- Serviço de Radiologia do Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - António Miguel Ferreira
- Serviço de Cardiologia do Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Unidade de Imagem Cardíaca Avançada, Hospital da Luz, Lisboa, Portugal
| | - António Hipólito Reis
- Laboratório de Pacing e Eletrofisiologia, Hospital Geral de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Hugo Marques
- Serviço de Radiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central; Unidade Imagem Cardíaca Avançada, Hospital da Luz Lisboa; Nova Medical School, Lisboa, Portugal
| | - Nuno Dias Ferreira
- Serviço de Cardiologia do Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Mário Oliveira
- Unidade de Arritmologia, Pacing e Eletrofisiologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| |
Collapse
|
10
|
Koshy AO, Swoboda PPP, Gierula J, Witte KK. Cardiac magnetic resonance in patients with cardiac resynchronization therapy: is it time to scan with resynchronization on? Europace 2020; 21:554-562. [PMID: 30608530 DOI: 10.1093/europace/euy299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/20/2018] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is recommended in international guidelines for patients with heart failure due to important left ventricular systolic dysfunction (or heart failure with reduced ejection fraction) and ventricular conduction tissue disease. Cardiac magnetic resonance (CMR) represents the most powerful imaging tool for dynamic assessment of the volumes and function of cardiac chambers but is rarely utilized in patients with CRT due to limitations on the device, programming and scanning. In this review, we explore the known utility of CMR in this cohort with discussion of the risks and potential benefits of scanning whilst CRT is active, including a practical strategy for conducting high quality scans safely. Our contention is that imaging in patients with CRT could be improved further by keeping resynchronization therapy active with resultant benefits on research and also patient outcomes.
Collapse
Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - Peter P P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| |
Collapse
|
11
|
Dacher JN, Gandjbakhch E, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Boveda S, Jacquier A. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices. Diagn Interv Imaging 2020; 101:507-517. [PMID: 32094095 DOI: 10.1016/j.diii.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.
Collapse
Affiliation(s)
- J-N Dacher
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France.
| | - E Gandjbakhch
- Sorbonne Universités, AP-HP, Heart Institute, La Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - J Taieb
- Hospital of Aix-en-Provence, Department of Cardiology, 13100 Aix-en-Provence, France
| | - M Chauvin
- Université de Strasbourg, CHU Strasbourg, Department of Cardiology, 67000 Strasbourg, France
| | - F Anselme
- Normandie UNIV, UNIROUEN, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - A Bartoli
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
| | - L Boyer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - L Cassagnes
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - H Cochet
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - B Dubourg
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France
| | - L Fauchier
- Université de Tours, CHU de Tours, Department of Cardiology, 37000 Tours, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Department of Cardiology, 44200 Nantes, France
| | - D Klug
- Université de Lille, CHRU de Lille, Department of Cardiology, 59000 Lille, France
| | - G Laurent
- Université de Dijon, CHU de Dijon, Department of Cardiology, 21000 Dijon, France
| | - J Mansourati
- Université de Bretagne Occidentale, CHU de Brest, Department of Cardiology, 29200 Brest, France
| | - E Marijon
- Université de Paris, AP-HP, Department of Cardiology, Georges-Pompidou European University Hospital, 75015 Paris, France
| | - P Maury
- Université de Toulouse, Inserm U1048, Department of Cardiology, Hospital Rangueil, 31059 Toulouse, France
| | - O Piot
- Centre Cardiologique du Nord, Department of Cardiology, 93200 Saint-Denis, France
| | - F Pontana
- Université de Lille, Inserm U1011, Department of Cardiovascular Radiology, Institut Cœur-Poumon, 59000 Lille, France
| | - F Sacher
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - N Sadoul
- Université de Nancy Lorraine, CHU de Nancy, Department of Cardiology, 54511 Vandœuvre-lès-Nancy, France
| | - S Boveda
- Clinique Pasteur, Department of Cardiology, 31076 Toulouse, France
| | - A Jacquier
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
| |
Collapse
|
12
|
Ning X, Li X, Fan X, Chen K, Hua W, Liu Z, Dai Y, Chen X, Lu M, Zhao S, Zhang S. 3.0 T magnetic resonance imaging scanning on different body regions in patients with pacemakers. J Interv Card Electrophysiol 2020; 61:545-550. [PMID: 32808082 DOI: 10.1007/s10840-020-00854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers. METHODS Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists. RESULTS Twenty-three MRI scans of different body regions (brain = 13, lumbar spine = 4, cervical spine = 2, and heart = 4) were performed, and the average time of a scan was 25 ± 11 min. No significant changes in sensing amplitude (atrial 3.1 ± 1.1 mV vs. 2.9 ± 1.2 mV, P = 0.71; ventricular 9.3 ± 3.5 mV vs. 10.2 ± 3.4 mV, P = 0.46), lead impedances (atrial 647 ± 146 Ω vs. 627 ± 151 Ω, P = 0.7; ventricular: 780 ± 247 Ω vs.711 ± 226 Ω, P = 0.36), or pacing threshold (atrial 0.6 ± 0.2 V/0.4 ms vs. 0.6 ± 0.2 V/0.4 ms, P = 0.71; ventricular 0.7 ± 0.3 V/0.4 ms vs. 0.7 ± 0.2 V/0.4 ms, P = 0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value. CONCLUSION Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.
Collapse
Affiliation(s)
- Xiaohui Ning
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaofei Li
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaohan Fan
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China.
| | - Keping Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Zhimin Liu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Yan Dai
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shihua Zhao
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| |
Collapse
|
13
|
Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions. J Thorac Imaging 2020; 35:W1-W17. [PMID: 31855948 DOI: 10.1097/rti.0000000000000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.
Collapse
|
14
|
Gandjbakhch E, Dacher JN, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Defaye P, Deharo JC, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Jacquier A, Boveda S. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging on magnetic resonance imaging in patients with cardiac electronic implantable devices. Arch Cardiovasc Dis 2020; 113:473-484. [DOI: 10.1016/j.acvd.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
|
15
|
An operational approach to the execution of MR examinations in patients with CIED. Radiol Med 2020; 125:1311-1321. [PMID: 32367321 DOI: 10.1007/s11547-020-01206-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
In the context of the increasing spread of cardiac active implantable heart devices (CIEDs) in the population and of the wide diagnostic/therapeutic utility of magnetic resonance (MRI) examinations, the goal of this paper is to provide the experience of the Santa Maria Nuova Hospital of the USL Tuscany Center in Florence and to report an organizational proposal to perform, in the hospital settings, MRI examinations on patients carrying CIED. This report is intended to show the operational choices of a Radiology Department which organizes this activity in accordance with the new Italian regulatory framework in the field of safety of MR sites (Ministero della Salute in Decreto Ministeriale 10 agosto 2018 Determinazione degli standard di sicurezza e impiego per le apparecchiature a risonanza magnetica, 2018).
Collapse
|
16
|
Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020. Anesthesiology 2020; 132:225-252. [DOI: 10.1097/aln.0000000000002821] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This practice advisory updates the “Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices,” adopted by the American Society of Anesthesiologists in 2010 and published in 2011. This updated advisory is intended for use by anesthesiologists and all other individuals who deliver or who are responsible for anesthesia care. The update may also serve as a resource for other physicians and healthcare professionals who manage patients with cardiac implantable electronic devices.
Supplemental Digital Content is available in the text.
Collapse
|
17
|
Bauer WR, Lau DH, Wollmann C, McGavigan A, Mansourati J, Reiter T, Frömer S, Ladd ME, Quick HH. Clinical safety of ProMRI implantable cardioverter-defibrillator systems during head and lower lumbar magnetic resonance imaging at 1.5 Tesla. Sci Rep 2019; 9:18243. [PMID: 31796767 PMCID: PMC6890633 DOI: 10.1038/s41598-019-54342-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/05/2019] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) has long been contraindicated in patients with implanted pacemakers, defibrillators, and cardiac resynchronisation therapy (CRT) devices due to the risk of adverse effects through electromagnetic interference. Since many recipients of these devices will have a lifetime indication for an MRI scan, the implantable systems should be developed as ‘MRI-conditional’ (be safe for the MRI environment under predefined conditions). We evaluated the clinical safety of several Biotronik ProMRI (‘MRI-conditional’) defibrillator and CRT systems during head and lower lumbar MRI scans at 1.5 Tesla. The study enrolled 194 patients at 22 sites in Australia, Canada, and Europe. At ≥9 weeks after device implantation, predefined, non-diagnostic, specific absorption rate (SAR)-intensive head and lower lumbar MRI scans (total ≈30 minutes per patient) were performed in 146 patients that fulfilled pre-procedure criteria. Three primary endpoints were evaluated: freedom from serious adverse device effects (SADEs) related to MRI and defibrillator/CRT (leading to death, hospitalisation, life-threatening condition, or potentially requiring implanted system revision or replacement), pacing threshold increase, and sensing amplitude decrease, all at the 1-month post-MRI clinical visit. No MRI-related SADE occurred. Lead values remained stable, measured in clinic and monitored daily by the manufacturer home monitoring technology.
Collapse
Affiliation(s)
- Wolfgang Rudolf Bauer
- Department of Internal Medicine I, Universitätsklinikum Würzburg, Würzburg, Germany.
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christian Wollmann
- Department of Internal Medicine III, Universitätsklinikum St. Pölten, St. Pölten, Austria.,Institute of Cardiovascular Research, Karl-Landsteiner Society, St. Pölten, Austria
| | | | - Jacques Mansourati
- Hôpital de la Cavale Blanche, University Hospital of Brest and University of Western Brittany, Brest, France
| | - Theresa Reiter
- Department of Internal Medicine I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Simone Frömer
- Centre for Clinical Research, BIOTRONIK SE & Co. KG, Berlin, Germany
| | - Mark E Ladd
- Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany.,Erwin L. Hahn Institute for MR Imaging, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
18
|
Zbinden R, Wollmann C, Brachmann J, Michaelsen J, Steinwender C, Kovoor P, Kelle S, McGavigan AD, Ching CK, Figtree GA, Schmidt J, Timmel T, Lotz J. Clinical safety of the ProMRI implantable cardioverter-defibrillator systems during head and lower lumbar magnetic resonance imaging at 3 T: results of the ProMRI 3T ENHANCED Master study. Europace 2019; 21:1678-1685. [PMID: 31322701 PMCID: PMC6826205 DOI: 10.1093/europace/euz189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/22/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS There have been no published studies on the safety of magnetic resonance imaging (MRI) at 3 Tesla (3 T) in patients with MRI-conditional implantable cardioverter-defibrillators (ICDs). The aim of this study was to assess clinical safety of the Biotronik ProMRI ICD system during non-diagnostic head and lower lumbar scans under 3 T MRI conditions. METHODS AND RESULTS The study enrolled 129 patients at 12 sites in Australia, Singapore, and Europe. Predefined head and lower lumbar MR scans (total duration ≈30 min) were performed in 112 patients. Three primary endpoints were evaluated from the pre-MRI to the 1-month post-MRI visit: (i) freedom from serious adverse device effects (SADEs) related to MRI (hypothesized to be >90%); (ii) pacing threshold invariance for all leads (geometric mean of the patient-wise ratios for 1 month vs. pre-MRI was hypothesized to be <1.07); and (iii) sensing amplitude invariance (geometric mean of the ratios was hypothesized to be >0.993). No MRI-related SADE occurred (SADE-free rate 100%, 95% confidence interval 95.98-100%). Pacing threshold and sensing amplitudes fulfilled the invariance hypotheses with high statistical significance (P < 0.0013). No threshold increase >0.5 V or sensing amplitude decrease by >50% was observed (secondary endpoints). Lead impedances, battery capacity, and detection and treatment of arrhythmias by ICDs were not affected by MRI scans. CONCLUSION The head and lower lumbar scans under specific 3 T MRI conditions were safe in the investigated MR-conditional ICD systems. There was no evidence of harm to the patients or any negative influence of the MRI scan on the implanted systems.
Collapse
Affiliation(s)
- Rainer Zbinden
- Klinik für Kardiologie, Stadtspital Triemli, Birmensdorferstrasse 497, Zurich, Switzerland
| | - Christian Wollmann
- Klinische Abteilung für Innere Medizin 3, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100 St. Pölten, Austria
| | - Johannes Brachmann
- II. Medizinische Klinik Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Ketschendorfer Str. 33, Coburg, Germany
| | - Jochen Michaelsen
- Klinik für Kardiologie, Angiologie und Schlafmedizin, Bonifatius Hospital Lingen GmbH, Wilhelmstr. 13, Lingen, Germany
| | - Clemens Steinwender
- Klinik für Kardiologie, Kepler Universitätsklinikum, Krankenhausstr. 9, Linz, Austria
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead (NSW), Australia
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin and Charité University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Andrew D McGavigan
- Department of Cardiology, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, Australia
| | - Chi Keong Ching
- Department of Electrophysiology, National Heart Centre of Singapore, 5 Hospital Drive Singapore, Singapore, Singapore
| | - Gemma A Figtree
- Kolling Institute, University of Sydney, Royal North Shore Hospital, Pacific Hwy, St Leonards (NSW), Australia
| | - Jan Schmidt
- Klinik für Kardiologie, Pneumologie & Angiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, Düsseldorf, Germany
| | - Tobias Timmel
- Center for Clinical Research, Biotronik SE & Co. KG, Woermannkehre 1, Berlin, Germany
| | - Joachim Lotz
- Instituts für Diagnostische und Interventionelle Radiologie, Georg-August-Universität, Robert-Koch-Str. 40, Göttingen, Germany
| |
Collapse
|
19
|
[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.
Collapse
|
20
|
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
|
21
|
Real-World Evaluation of Magnetic Resonance Imaging in Patients With a Magnetic Resonance Imaging Conditional Pacemaker System. JACC Clin Electrophysiol 2017; 3:1231-1239. [DOI: 10.1016/j.jacep.2017.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/11/2017] [Accepted: 05/26/2017] [Indexed: 11/19/2022]
|
22
|
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
|
23
|
Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
|
24
|
Woodard PK, Ho VB, Akers SR, Beache G, Brown RK, Cummings KW, Greenberg SB, Min JK, Stillman AE, Stojanovska J, Jacobs JE. ACR Appropriateness Criteria ® Known or Suspected Congenital Heart Disease in the Adult. J Am Coll Radiol 2017; 14:S166-S176. [DOI: 10.1016/j.jacr.2017.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/16/2022]
|
25
|
SHAH ANANDD, PATEL ADARSHU, KNEZEVIC ANDREA, HOSKINS MICHAELH, HIRSH DAVIDS, MERCHANT FAISALM, EL CHAMI MIKHAELF, DELURGIO DAVIDB, PATEL ANSHULM, LEON ANGELR, LANGBERG JONATHANJ, LLOYD MICHAELS. Clinical Performance of Magnetic Resonance Imaging Conditional and Nonconditional Cardiac Implantable Electronic Devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:467-475. [DOI: 10.1111/pace.13060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/29/2017] [Accepted: 02/11/2017] [Indexed: 12/01/2022]
Affiliation(s)
- ANAND D. SHAH
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | | | - ANDREA KNEZEVIC
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics; Emory University; Atlanta Georgia
| | - MICHAEL H. HOSKINS
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - DAVID S. HIRSH
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - FAISAL M. MERCHANT
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - MIKHAEL F. EL CHAMI
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - DAVID B. DELURGIO
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - ANSHUL M. PATEL
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - ANGEL R. LEON
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | | | - MICHAEL S. LLOYD
- Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| |
Collapse
|
26
|
MR-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter‑Defibrillatoren. KARDIOLOGE 2017. [DOI: 10.1007/s12181-017-0124-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Miller JD, Nazarian S, Halperin HR. Implantable Electronic Cardiac Devices and Compatibility With Magnetic Resonance Imaging. J Am Coll Cardiol 2016; 68:1590-8. [DOI: 10.1016/j.jacc.2016.06.068] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
|