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Kakarla S, Abhilash SP, Valakkada J, Namboodiri N. Feasibility of cardiac magnetic resonance imaging in temporary permanent pacemaker implants in pediatric myocarditis and complete atrioventricular block. J Arrhythm 2024; 40:385-389. [PMID: 38586858 PMCID: PMC10995590 DOI: 10.1002/joa3.13007] [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: 11/25/2023] [Revised: 01/29/2024] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Background Diagnosing myocarditis in children presenting with complete AV block (CAVB) is challenging. Temporary permanent pacing support using standard transvenous active fixation lead can be inserted percutaneously until recovery. However, access to cardiac magnetic resonance (CMR) imaging may be limited due to safety concerns. Cases We report three cases where CMR was performed using temporary permanent pacemaker in situ. We evaluated the effect of device artefacts on image quality and examined any instances of device malfunction. Conclusion In children with CAVB and myocarditis, a temporary permanent pacemaker can provide reliable pacing until recovery, and CMR can be safely performed with the implanted pacemaker without compromising image quality.
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Affiliation(s)
- Saikiran Kakarla
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Sreevilasam P. Abhilash
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional RadiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Narayanan Namboodiri
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
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2
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Fyenbo DB, Jensen MSK, Kronborg MB, Kristensen J, Nielsen JC, Witt CT. Magnetic resonance imaging in patients with temporary external pacemakers. Europace 2022; 24:1960-1966. [PMID: 36006800 DOI: 10.1093/europace/euac147] [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: 04/06/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS To describe safety and feasibility of magnetic resonance imaging (MRI) in patients with transvenous temporary external pacemakers and whether artefacts affect the diagnostic image quality during cardiac MRI. METHODS AND RESULTS We reviewed records of all patients treated with temporary external pacing between 2016 and 2020 at a tertiary centre. Temporary pacing was established using a transvenous standard active fixation pacing lead inserted percutaneously and connected to a MRI-conditional pacemaker taped to the skin. All patients undergoing cardiac or non-cardiac MRI during temporary transvenous pacing were identified. Before MRI, devices were programmed according to guidelines for permanent pacemakers, and patients were monitored with continuous electrocardiogram during MRI. Of 827 consecutive patients receiving a temporary external pacemaker, a total of 44 (5%) patients underwent MRI (mean age 71 years, 13 [30%] females). Cardiac MRI was performed in 22 (50%) patients, while MRI of cerebrum, spine, and other regions was performed in the remaining patients. Median time from implantation of the temporary device to MRI was 6 (3-11) days. During MRI, we observed no device-related malfunction or arrhythmia. Nor did we detect any change in lead sensing, impedance, or pacing threshold. We observed no artefacts from the lead or pacemaker compromising the diagnostic image quality of cardiac MRI. MRI provided information to guide the clinical management in all cases. CONCLUSION MRI is feasible and safe in patients with temporary external pacing established with a regular MRI-conditional pacemaker and a standard active fixation lead. No artefacts compromised the diagnostic image quality.
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Affiliation(s)
- Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Morten Steen Kvistholm Jensen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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4
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Vuorinen AM, Lehtonen J, Pakarinen S, Holmström M, Kivistö S, Kaasalainen T. Cardiac Magnetic Resonance Imaging-Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing. J Am Heart Assoc 2022; 11:e024257. [PMID: 35658507 PMCID: PMC9238739 DOI: 10.1161/jaha.121.024257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18-F-fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high-degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jukka Lehtonen
- Heart and Lung Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sami Pakarinen
- Haartman HospitalUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Miia Holmström
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sari Kivistö
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Touko Kaasalainen
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
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Lebel K, Mondesert B, Robillard J, Pham M, Terrone D, Tan S. 2020 MR Safety for Cardiac Devices: An Update for Radiologists. Can Assoc Radiol J 2020; 72:814-830. [DOI: 10.1177/0846537120967701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.
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Affiliation(s)
- Kiana Lebel
- The University of Sherbrooke, Montreal, Quebec, Canada
| | | | | | - Magali Pham
- Montreal Heart Institute, Montreal, Quebec, Canada
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Kovach C, Swirka M, McGuinn E, Honce JM, Groves DW, Tumolo AZ. Magnetic resonance imaging in a patient with temporary external pacemaker. HeartRhythm Case Rep 2020; 6:637-640. [PMID: 32983883 PMCID: PMC7498632 DOI: 10.1016/j.hrcr.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Christopher Kovach
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Mallory Swirka
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Erin McGuinn
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - Justin M Honce
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado
| | - Daniel W Groves
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado.,Department of Radiology, University of Colorado Hospital, Aurora, Colorado
| | - Alexis Z Tumolo
- Division of Cardiology, Department of Medicine, University of Colorado Hospital, Aurora, Colorado
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