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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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Tian Y, Nayak KS. New clinical opportunities of low-field MRI: heart, lung, body, and musculoskeletal. MAGMA (NEW YORK, N.Y.) 2024; 37:1-14. [PMID: 37902898 PMCID: PMC10876830 DOI: 10.1007/s10334-023-01123-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023]
Abstract
Contemporary whole-body low-field MRI scanners (< 1 T) present new and exciting opportunities for improved body imaging. The fundamental reason is that the reduced off-resonance and reduced SAR provide substantially increased flexibility in the design of MRI pulse sequences. Promising body applications include lung parenchyma imaging, imaging adjacent to metallic implants, cardiac imaging, and dynamic imaging in general. The lower cost of such systems may make MRI favorable for screening high-risk populations and population health research, and the more open configurations allowed may prove favorable for obese subjects and for pregnant women. This article summarizes promising body applications for contemporary whole-body low-field MRI systems, with a focus on new platforms developed within the past 5 years. This is an active area of research, and one can expect many improvements as MRI physicists fully explore the landscape of pulse sequences that are feasible, and as clinicians apply these to patient populations.
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Affiliation(s)
- Ye Tian
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, CA, 90089-2564, USA.
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, CA, 90089-2564, USA
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Hamilton JI, Truesdell W, Galizia M, Burris N, Agarwal P, Seiberlich N. A low-rank deep image prior reconstruction for free-breathing ungated spiral functional CMR at 0.55 T and 1.5 T. MAGMA (NEW YORK, N.Y.) 2023; 36:451-464. [PMID: 37043121 PMCID: PMC11017470 DOI: 10.1007/s10334-023-01088-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/02/2023] [Accepted: 04/01/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE This study combines a deep image prior with low-rank subspace modeling to enable real-time (free-breathing and ungated) functional cardiac imaging on a commercial 0.55 T scanner. MATERIALS AND METHODS The proposed low-rank deep image prior (LR-DIP) uses two u-nets to generate spatial and temporal basis functions that are combined to yield dynamic images, with no need for additional training data. Simulations and scans in 13 healthy subjects were performed at 0.55 T and 1.5 T using a golden angle spiral bSSFP sequence with images reconstructed using [Formula: see text]-ESPIRiT, low-rank plus sparse (L + S) matrix completion, and LR-DIP. Cartesian breath-held ECG-gated cine images were acquired for reference at 1.5 T. Two cardiothoracic radiologists rated images on a 1-5 scale for various categories, and LV function measurements were compared. RESULTS LR-DIP yielded the lowest errors in simulations, especially at high acceleration factors (R [Formula: see text] 8). LR-DIP ejection fraction measurements agreed with 1.5 T reference values (mean bias - 0.3% at 0.55 T and - 0.2% at 1.5 T). Compared to reference images, LR-DIP images received similar ratings at 1.5 T (all categories above 3.9) and slightly lower at 0.55 T (above 3.4). CONCLUSION Feasibility of real-time functional cardiac imaging using a low-rank deep image prior reconstruction was demonstrated in healthy subjects on a commercial 0.55 T scanner.
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Affiliation(s)
- Jesse I Hamilton
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - William Truesdell
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA
| | - Mauricio Galizia
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA
| | - Nicholas Burris
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA
| | - Prachi Agarwal
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1301 Catherine St, Ann Arbor, MI, 48109-1590, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Goodwin E, Fogelson B, Cox JW, Mahlow WJ. An algorithm for pacing and cardioverting electronic devices undergoing magnetic resonance imaging: The PACED-MRI protocol. Magn Reson Imaging 2023; 96:44-49. [PMID: 36441043 DOI: 10.1016/j.mri.2022.10.012] [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: 05/05/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cardiac implantable electronic devices (CIEDs) have traditionally been a contraindication for magnetic resonance imaging (MRI). However, there is an increasing amount of literature to suggest that MRI can be safely performed in select patients with pacemakers and implantable cardioverter defibrillators by following a standardized protocol. We created an institutional protocol, made accessible as an online form, that is primarily technologist-driven and does not require direct electrophysiologist supervision. The purpose of this study was to evaluate the PACEDMRI protocol for screening and completing MRI in patients with MR conditional CIEDs. SUBJECTS AND METHODS After the implementation of our standardized PACED-MRI protocol, patients with MR conditional CIEDs who were referred for MRI were included in the study. On the day of the MRI, the device company representative utilized our protocol accessed through PACEDMRI.com. If all parameters and criteria within the protocol were met, the examination proceeded. The device representative programed the CIED to the appropriate mode for MRI as instructed by the PACED-MRI protocol. CIED interrogation was performed immediately before and after MRI. The on-call electrophysiology nurse practitioner was notified only if the protocol instructed the team to not proceed with MRI. CIED programming changes, malfunctions, and intraprocedural events were documented. Additionally, any adverse outcomes were recorded including peri-MRI symptom onset, arrhythmia, and death. RESULTS One hundred thirty-eight MRI examinations were performed on patients with MR conditional CIEDs (100 pacemakers: 38 implantable cardiac defibrillators). There was no incidence of symptom onset requiring early termination of the MRI, death, or arrhythmic events during or after MRI. No significant changes in lead parameters, including sensing amplitudes, lead thresholds, or lead impedances were noted on post-MRI device interrogation. Out of the 138 completed MRIs, the on-call electrophysiology provider was notified on one, non-urgent occasion. CONCLUSION The implementation of the standardized, technologists-driven PACED-MRI protocol allowed for a multidisciplinary approach to MRI for patients with MR conditional CIEDs. This study demonstrates that the PACED-MRI protocol can be used for patients with MR conditional CIEDs undergoing MRI without the need for direct electrophysiologist supervision.
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Affiliation(s)
- Elliott Goodwin
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - Benjamin Fogelson
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James W Cox
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - William J Mahlow
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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5
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Gopalakrishnan PP, Gevenosky L, Biederman RWW. Feasibility of MRI in patients with non-Pacemaker/Defibrillator metallic devices and abandoned leads. ACTA ACUST UNITED AC 2021; 14:83-93. [PMID: 33777288 DOI: 10.4236/jbise.2021.143009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. Background Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. Methods We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. Results The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up. Conclusions With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
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Affiliation(s)
| | - Loretta Gevenosky
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
| | - Robert W W Biederman
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
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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.
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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
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Dacher JN, Gandjbakhch E, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Boveda S, Jacquier A. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices. Diagn Interv Imaging 2020; 101:507-517. [PMID: 32094095 DOI: 10.1016/j.diii.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.
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Affiliation(s)
- J-N Dacher
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France.
| | - E Gandjbakhch
- Sorbonne Universités, AP-HP, Heart Institute, La Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - J Taieb
- Hospital of Aix-en-Provence, Department of Cardiology, 13100 Aix-en-Provence, France
| | - M Chauvin
- Université de Strasbourg, CHU Strasbourg, Department of Cardiology, 67000 Strasbourg, France
| | - F Anselme
- Normandie UNIV, UNIROUEN, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - A Bartoli
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
| | - L Boyer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - L Cassagnes
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - H Cochet
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - B Dubourg
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France
| | - L Fauchier
- Université de Tours, CHU de Tours, Department of Cardiology, 37000 Tours, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Department of Cardiology, 44200 Nantes, France
| | - D Klug
- Université de Lille, CHRU de Lille, Department of Cardiology, 59000 Lille, France
| | - G Laurent
- Université de Dijon, CHU de Dijon, Department of Cardiology, 21000 Dijon, France
| | - J Mansourati
- Université de Bretagne Occidentale, CHU de Brest, Department of Cardiology, 29200 Brest, France
| | - E Marijon
- Université de Paris, AP-HP, Department of Cardiology, Georges-Pompidou European University Hospital, 75015 Paris, France
| | - P Maury
- Université de Toulouse, Inserm U1048, Department of Cardiology, Hospital Rangueil, 31059 Toulouse, France
| | - O Piot
- Centre Cardiologique du Nord, Department of Cardiology, 93200 Saint-Denis, France
| | - F Pontana
- Université de Lille, Inserm U1011, Department of Cardiovascular Radiology, Institut Cœur-Poumon, 59000 Lille, France
| | - F Sacher
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - N Sadoul
- Université de Nancy Lorraine, CHU de Nancy, Department of Cardiology, 54511 Vandœuvre-lès-Nancy, France
| | - S Boveda
- Clinique Pasteur, Department of Cardiology, 31076 Toulouse, France
| | - A Jacquier
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
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Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions. J Thorac Imaging 2020; 35:W1-W17. [PMID: 31855948 DOI: 10.1097/rti.0000000000000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.
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Varghese J, Craft J, Crabtree CD, Liu Y, Jin N, Chow K, Ahmad R, Simonetti OP. Assessment of cardiac function, blood flow and myocardial tissue relaxation parameters at 0.35 T. NMR IN BIOMEDICINE 2020; 33:e4317. [PMID: 32363644 DOI: 10.1002/nbm.4317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 06/11/2023]
Abstract
A low field strength (B0) system could increase cardiac MRI availability for patients otherwise contraindicated at higher field. Lower equipment costs could also broaden cardiac MR accessibility. The current study investigated the feasibility of cardiac function with steady-state free precession and flow assessment with phase contrast (PC) cine images at 0.35 T, and evaluated differences in myocardial relaxation times using quantitative T1, T2 and T2* maps by comparison with 1.5 and 3 T results in a small cohort of six healthy volunteers. Signal-to-noise ratio (SNR) differences across systems were characterized with proton density-weighted spin echo phantom data. SNR at 0.35 T was lower by factors of 5.5 and 15.0 compared with the 1.5 and 3 T systems used in this study. All cine images at 0.35 T scored 3 or greater on a five-point image quality scale. Normalized blood-myocardium contrast in cine images, left ventricular volumes (end diastolic volume, end systolic volume) and function (ejection fraction and stroke volume) measures at 0.35 T matched 1.5 and 3 T results. Phase-to-noise ratio in 0.35 T PC images (11.7 ± 1.9) was lower than 1.5 T (18.7 ± 5.2) and 3 T (44.9 ± 16.5). Peak velocity and stroke volume determined from PC images were similar across systems. Myocardial T1 increased (564 ± 13 ms at 0.35 T, 955 ± 19 ms at 1.5 T and 1200 ± 35 ms at 3 T) while T2 (59 ± 4 ms at 0.35 T, 49 ± 3 ms at 1.5 T and 40 ± 2 ms at 3 T) and T2* (42 ± 8 ms at 0.35 T, 33 ± 6 ms at 1.5 T and 24 ± 3 ms at 3 T) decreased with increasing B0. Despite SNR deficits, cardiovascular function, flow assessment and myocardial relaxation parameter mapping is feasible at 0.35 T using standard cardiovascular imaging sequences.
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Affiliation(s)
- Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jason Craft
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
- St. Francis Hospital, Roslyn, New York, USA
| | - Christopher D Crabtree
- Kinesiology, Health and Exercise Sciences, Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions, Columbus, Ohio
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions, Chicago, Illinois
| | - Rizwan Ahmad
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, Ohio
| | - Orlando P Simonetti
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Radiology, The Ohio State University, Columbus, Ohio
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10
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Gandjbakhch E, Dacher JN, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Defaye P, Deharo JC, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Jacquier A, Boveda S. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging on magnetic resonance imaging in patients with cardiac electronic implantable devices. Arch Cardiovasc Dis 2020; 113:473-484. [DOI: 10.1016/j.acvd.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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11
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Restivo MC, Ramasawmy R, Bandettini WP, Herzka DA, Campbell-Washburn AE. Efficient spiral in-out and EPI balanced steady-state free precession cine imaging using a high-performance 0.55T MRI. Magn Reson Med 2020; 84:2364-2375. [PMID: 32291845 DOI: 10.1002/mrm.28278] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Low-field MRI offers favorable physical properties for SNR-efficient long readout acquisitions such as spiral and EPI. We used a 0.55 tesla (T) MRI system equipped with high-performance hardware to increase the sampling duty cycle and extend the TR of balanced steady-state free precession (bSSFP) cardiac cine acquisitions, which typically are limited by banding artifacts. METHODS We developed a high-efficiency spiral in-out bSSFP acquisition, with zeroth- and first-gradient moment nulling, and an EPI bSSFP acquisition for cardiac cine imaging using a contemporary MRI system modified to operate at 0.55T. Spiral in-out and EPI bSSFP cine protocols, with TR = 8 ms, were designed to maintain both spatiotemporal resolution and breath-hold length. Simulations, phantom imaging, and healthy volunteer imaging studies (n = 12) were performed to assess SNR and image quality using these high sampling duty-cycle bSSFP sequences. RESULTS Spiral in-out bSSFP performed favorably at 0.55T and generated good image quality, whereas EPI bSSFP suffered motion and flow artifacts. There was no difference in ejection fraction comparing spiral in-out with standard Cartesian imaging. Moreover, human images demonstrated a 79% ± 21% increase in myocardial SNR using spiral in-out bSSFP and 50% ± 14% increase in SNR using EPI bSSFP as compared with the reference Cartesian acquisition. Spiral in-out acquisitions at 0.55T recovered 69% ± 14% of the myocardial SNR at 1.5T. CONCLUSION Efficient bSSFP spiral in-out provided high-quality cardiac cine imaging and SNR recovery on a high-performance 0.55T MRI system.
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Affiliation(s)
- Matthew C Restivo
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Daghighi S, Chan A, Kiani Nazarlou A, Hasan Z, Halimi M, Akbarzadeh F, Kazemi D, Daghighi MH, Fouladi DF. Clinical and histopathological outcome of cervical and chest MRI involving non-MRI-conditional cardiac pacemakers: a study using sheep models. Radiol Med 2020; 125:706-714. [PMID: 32206985 DOI: 10.1007/s11547-020-01173-3] [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: 02/02/2020] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
AIM To examine the clinical and histopathological consequences of MRI in sheep implanted with non-MRI-conditional cardiac pacemakers. MATERIALS AND METHODS Under general anesthesia, active fixation leads of two dual-chamber, non-MRI-conditional cardiac pacemakers (St. Jude Medical and Medtronic) were implanted either at the right ventricular apex or at the right atrium of two male sheep and connected to the V and A channels of the pacemakers, respectively. The generators were placed in cervical subcutaneous pockets. On day 5, both sheep underwent 1.5 T cervical and chest MRI with continuous electrocardiogram monitoring. Obtained sequences were T1-weighted (T1W), T2-weighted (T2W), T2-gradient echo and diffusion weighted (DW). The employed modes were OVO, VOO and VVI for one sheep and OAO, AOO and AAI for the other (unipolar and bipolar configuration of pacing and sensing for both). Battery impedance, pacing lead impedance, intrinsic amplitude and capture thresholds were checked at baseline and after each sequence, as well as 48 h after imaging. Histopathological examination of the cardiac tissue around the lead tip was performed 4 weeks post-imaging. RESULTS No significant changes in device position or configuration were observed during or after MRI. Clinical outcome was uneventful in both sheep. Minor inflammatory and necrotic changes were reported after histopathological examination of the cardiac tissue around the lead tip. CONCLUSION 1.5 T MRI of two implanted non-MRI-conditional pacemakers was found safe in terms of device configuration and stability, clinical outcome and cardiac tissue histopathological findings.
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Affiliation(s)
- Shadi Daghighi
- Department of Radiology, University of California, San Diego, CA, USA
| | - Aimee Chan
- Department of Radiology, University of Toronto (Sunnybrook), Toronto, Ontario, Canada
| | - Ali Kiani Nazarlou
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Hasan
- Department of Pathology, University of Tennessee, Memphis, TN, USA
| | - Monireh Halimi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariborz Akbarzadeh
- Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davoud Kazemi
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine Tabriz Branch, Islamic Azad University, Tabriz, Iran
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Pavlović N, Đula K, Kuharić I, Brusich S, Velagić V, Jurišić Z, Bakotić Z, Anić A, Pezo Nikolić B, Radeljić V, Čubranić Z, Zeljković I, Zadravec D, Manola Š. MANAGEMENT OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES UNDERGOING MAGNETIC RESONANCE IMAGING - PROPOSAL FOR UNIFIED HOSPITAL PROTOCOL: CROATIAN WORKING GROUP ON ARRHYTHMIAS AND CARDIAC PACING. Acta Clin Croat 2020; 59:119-125. [PMID: 32724282 PMCID: PMC7382882 DOI: 10.20471/acc.2020.59.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.
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Affiliation(s)
- Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Kristijan Đula
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Kuharić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Sandro Brusich
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vedran Velagić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zrinka Jurišić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zoran Bakotić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ante Anić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Borka Pezo Nikolić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zlatko Čubranić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Zeljković
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Dijana Zadravec
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
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Safety and efficiency of low-field magnetic resonance imaging in patients with cardiac rhythm management devices. Eur J Radiol 2019; 118:96-100. [PMID: 31439265 DOI: 10.1016/j.ejrad.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/18/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Low-field magnetic resonance imaging (MRI), i.e. MRI with a static magnetic field strength <0.5 T, has been reported to be safe in patients with pacemakers, however there are no data about the safety of low-field MRI in patients with implantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy (CRT). We aimed to investigate the safety and diagnostic efficiency of routine low-field MRI in patients with different devices for cardiac rhythm management (i.e. pacemakers and ICD, including devices with CRT). METHOD MRI scans of 446 regions of interest were evaluated with field strength of 0.2 T in 338 patients (62% male; age at MRI scan 76.1 ± 9.2 years; time since device implantation 4.1 ± 3.2 years) with cardiac rhythm management devices (298 pacemakers, 25 ICD, 8 CRT-ICD, and 7 CRT pacemakers). This analysis included 62 pacemaker-dependent patients (18.3%), 52 patients with 1.5-Tesla-MR conditional pacemakers (15.4%) and 13 patients with abandoned leads (3.9%). RESULTS Except for one examination, which was interrupted because of recurrent severe nausea, all MRI scans could be analyzed efficiently. No induction of arrhythmia or inhibition of pacemaker function occurred. Compared to the device interrogation before MRI, there were no significant changes in battery voltage, pacing capture threshold, sensing of intrinsic ECG, lead impedance, as well as shock impedance in ICD devices after completed examination. CONCLUSIONS Low-field MRI examinations (0.2 T) were efficient and safe regarding clinical and technical complications in patients with devices for cardiac rhythm management, even in case of pacemaker-dependency or the presence of abandoned leads.
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Gach HM, Green OL, Cuculich PS, Wittland EJ, Marko A, Luchtefeld ME, Entwistle JM, Yang D, Wilber DJ, Mutic S, Robinson CG. Lessons Learned From the First Human Low-Field MRI Guided Radiation Therapy of the Heart in the Presence of an Implantable Cardiac Defibrillator. Pract Radiat Oncol 2019; 9:274-279. [DOI: 10.1016/j.prro.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/18/2019] [Accepted: 02/10/2019] [Indexed: 11/16/2022]
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16
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Stawiarski K, Sorajja D, Ramakrishna H. Magnetic Resonance and Computed Tomography Imaging in Patients with Cardiovascular Implantable Electronic Devices: Analysis of Expert Consensus Data and Implications for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2018; 32:2817-2822. [DOI: 10.1053/j.jvca.2018.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/11/2022]
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17
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Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A. MRI in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 289:281-292. [DOI: 10.1148/radiol.2018180285] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Muthalaly
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Yin Ge
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Raymond Y. Kwong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Arthur Nasis
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
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18
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Boone CE, Wojtasiewicz T, Moukheiber E, Butala A, Jordao L, Mills KA, Sair H, Anderson WS. MR-Guided Functional Neurosurgery: Laser Ablation and Deep Brain Stimulation. Top Magn Reson Imaging 2018; 27:171-177. [PMID: 29870469 DOI: 10.1097/rmr.0000000000000152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is increasingly implemented for image-guided procedures in functional neurosurgery. iMRI facilitates accurate electrode implantation for deep brain stimulation (DBS) and is currently an alternative method for DBS electrode targeting. The application of iMRI also allows for greater accuracy and precision in laser-induced thermal therapy (LITT). The expanding use of functional neurosurgical procedures makes safety and feasibility of iMRI important considerations, particularly in patients with comorbidities or complex medical histories. We review here the applications of iMRI and discuss its safety, feasibility, and limitations in functional neurosurgery.To motivate discussion of this topic, we also present a 52-year-old patient with an implanted cardioverter-defibrillator (ICD) who successfully underwent iMRI-guided DBS electrode implantation for advanced Parkinson disease (PD). Neither iMRI nor the passage of electrical current through the implanted DBS electrodes demonstrated detectable interference in ICD function. This case demonstrates that, even in complex clinical contexts, iMRI is a promising tool that merits further exploration for procedures requiring highly accurate and precise identification of target structures.
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Affiliation(s)
| | | | | | | | | | | | - Haris Sair
- Department of Radiology, Neuroradiology, The Johns Hopkins University, Baltimore, MD
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19
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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
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20
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Bertelsen L, Petersen HH, Philbert BT, Svendsen JH, Thomsen C, Vejlstrup N. Safety of magnetic resonance scanning without monitoring of patients with pacemakers. Europace 2018; 19:818-823. [PMID: 27738069 DOI: 10.1093/europace/euw066] [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: 04/27/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The objective of this study was to investigate whether it is safe to perform 1.5-Tesla magnetic resonance imaging (MRI) scans in pacemaker (PM) patients without pulse oximetry or electrocardiogram monitoring and with no special specific absorption rate (SAR) or time limits, provided that the PMs are interrogated and programmed to asynchronous mode prior to the scan. Methods and results This study reports the outcome of 207 MRI scans on PM patients at Rigshospitalet, Copenhagen University Hospital from June 2010 to September 2013. All MRIs were performed with the PMs in asynchronous mode and without additional monitoring. There were no adverse events registered among the PM patients during the study period. The only statistically significant change after MRI scans was a small, but clinically insignificant increase in atrial sense. No occurrences of reprogramming to power-on-reset were registered. Conclusion It is possible to perform MRI scans relatively safely in PM patients without additional monitoring or change in the normal MRI protocol, given that the PM has been assessed and reprogrammed prior to MRI. This is especially important to remember in the acute setting where MRI scans may be delayed when monitoring facilities are unavailable.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Helen Høgh Petersen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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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: 15] [Impact Index Per Article: 2.1] [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.
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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
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22
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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]
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23
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Simonetti OP, Ahmad R. Low-Field Cardiac Magnetic Resonance Imaging: A Compelling Case for Cardiac Magnetic Resonance's Future. Circ Cardiovasc Imaging 2017; 10:e005446. [PMID: 28611117 PMCID: PMC5659627 DOI: 10.1161/circimaging.117.005446] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orlando P Simonetti
- From the Department of Internal Medicine, Division of Cardiovascular Medicine (O.P.S.), Department of Radiology (O.P.S.), Dorothy M. Davis Heart and Lung Research Institute (O.P.S., R.A.), and Department of Electrical and Computer Engineering (R.A.), The Ohio State University, Columbus.
| | - Rizwan Ahmad
- From the Department of Internal Medicine, Division of Cardiovascular Medicine (O.P.S.), Department of Radiology (O.P.S.), Dorothy M. Davis Heart and Lung Research Institute (O.P.S., R.A.), and Department of Electrical and Computer Engineering (R.A.), The Ohio State University, Columbus
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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]
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25
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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]
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26
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Nordbeck P, Ertl G, Ritter O. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come? Eur Heart J 2015; 36:1505-11. [PMID: 25796053 PMCID: PMC4475571 DOI: 10.1093/eurheartj/ehv086] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers.
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Affiliation(s)
- Peter Nordbeck
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
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Hawryluk Ł, Sterliński M, Marczak M, Miśko J, Podgórski JK, Szwed H. The use of 1.5 T magnetic resonance imaging for therapeutic decisions in patients with cardiac implantable electronic devices and significant neurological, neurosurgical and neuro-oncology diagnostic indications. Neurol Neurochir Pol 2015; 49:16-23. [PMID: 25666768 DOI: 10.1016/j.pjnns.2014.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Between September 2009 and May 2014 the classification of 36 patients with cardiac implantable electronic devices (CIEDs) in terms of the feasibility of MRI scanning due to strong clinical indications was carried out. Finally MRI examinations were performed in 20 patients, of whom 27 studies were conducted and a total number of 35 anatomical regions were scanned. Neurological, neurosurgical and neuro-oncology indications for MRI were reported in 19 patients (95%) in whom 26 MRI studies (96.3%) were performed, and 34 anatomical regions (97.1%) were scanned. One patient had indications for MRI in the field of cardiology. Medical information obtained from 27 MRI studies allowed decisions to be made regarding the treatment in all patients. After 8 studies (29.6%), patients were classified into 9 different neurosurgical procedures. In the case of the remaining 19 studies (70.4%), there were no indications for surgical treatment and the decisions to implement conservative treatment were made. There were no complications related to the implanted CIEDs observed: neither immediate nor in the follow-up. CONCLUSIONS
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Affiliation(s)
- Łukasz Hawryluk
- The Second Department of Coronary Artery Disease, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
| | - Maciej Sterliński
- The Second Department of Coronary Artery Disease, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland.
| | - Jolanta Miśko
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland.
| | | | - Hanna Szwed
- The Second Department of Coronary Artery Disease, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
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Ferreira AM, Costa F, Tralhão A, Marques H, Cardim N, Adragão P. MRI-conditional pacemakers: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:115-24. [PMID: 24851058 PMCID: PMC4019608 DOI: 10.2147/mder.s44063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Use of both magnetic resonance imaging (MRI) and pacing devices has undergone remarkable growth in recent years, and it is estimated that the majority of patients with pacemakers will need an MRI during their lifetime. These investigations will generally be denied due to the potentially dangerous interactions between cardiac devices and the magnetic fields and radio frequency energy used in MRI. Despite the increasing reports of uneventful scanning in selected patients with conventional pacemakers under close surveillance, MRI is still contraindicated in those circumstances and cannot be considered a routine procedure. These limitations prompted a series of modifications in generator and lead engineering, designed to minimize interactions that could compromise device function and patient safety. The resulting MRI-conditional pacemakers were first introduced in 2008 and the clinical experience gathered so far supports their safety in the MRI environment if certain conditions are fulfilled. With this technology, new questions and controversies arise regarding patient selection, clinical impact, and cost-effectiveness. In this review, we discuss the potential risks of MRI in patients with electronic cardiac devices and present updated information regarding the features of MRI-conditional pacemakers and the clinical experience with currently available models. Finally, we provide some guidance on how to scan patients who have these devices and discuss future directions in the field.
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Affiliation(s)
- António M Ferreira
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Francisco Costa
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - António Tralhão
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Hugo Marques
- Radiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Pedro Adragão
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
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29
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013; 15:1070-118. [PMID: 23801827 DOI: 10.1093/europace/eut206] [Citation(s) in RCA: 748] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
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- Department of Cardiology, Ospedali del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna, (GE) Italy
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30
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34:2281-329. [PMID: 23801822 DOI: 10.1093/eurheartj/eht150] [Citation(s) in RCA: 1439] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna, (GE) Italy.
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Nazarian S, Beinart R, Halperin HR. Magnetic Resonance Imaging and Implantable Devices. Circ Arrhythm Electrophysiol 2013; 6:419-28. [DOI: 10.1161/circep.113.000116] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saman Nazarian
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Beinart
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Henry R. Halperin
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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32
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Nordbeck P, Bauer WR, Ritter O. Comments on 'Safe magnetic resonance image scanning of the pacemaker patient: current technologies and future directions'. Europace 2012; 14:1532; author reply 1532-3. [DOI: 10.1093/europace/eus112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bovenschulte H, Schlüter-Brust K, Liebig T, Erdmann E, Eysel P, Zobel C. MRI in patients with pacemakers: overview and procedural management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:270-5. [PMID: 22567062 DOI: 10.3238/arztebl.2012.0270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is generally contraindicated for patients with a pacemaker (PM) or implantable cardiac defibrillator (ICD), because of the risk of life-threatening interference with the device. Nevertheless, the question whether to perform MRI despite the presence of these devices can still arise when MRI is vitally indicated. In some hospitals, special precautionary measures are taken so that MRI can be performed in such cases. METHODS This review is based on the authors' experience in 42 patients who underwent MRI at our university hospital, on the pertinent literature, and on the recommendations of medical societies. RESULTS Because of its excellent image quality, MRI is often an indispensable diagnostic tool. Structured multidisciplinary management enables it to be performed safely even in patients with a PM or ICD. Pre- and post-MRI checks of the device are recommended, as well as extensive monitoring and the availability of the necessary personnel to deal with an emergency. In general, the pacing and defibrillator functions should be deactivated; for pacemaker-dependent patients, the asynchronous pacing mode should be activated. No serious incidents have occurred when these precautions have been observed, either among our own patients or in the literature. Newer PM systems have been approved for MRI scanning under certain conditions. CONCLUSION In patients with a PM or ICD, the benefit of MRI may far outweigh its risks if the indication has been established for the particular patient as an interdisciplinary decision and if the appropriate precautions are observed during scanning. Now that newer PM systems have been approved for MRI scanning, the problem seems close to being solved.
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Maff S, Paffoni P, Perucca A, Signorotti F, Dellavesa P, Parravicini U. Pseudo ?end of life? indication after electromagnetic field exposure: An unusual effect of magnetic resonance imaging on implanted cardioverter defibrillator. Int J Cardiol 2012; 156:e36-9. [DOI: 10.1016/j.ijcard.2011.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 08/13/2011] [Indexed: 11/29/2022]
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Shinbane JS, Colletti PM, Shellock FG. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs. J Cardiovasc Magn Reson 2011; 13:63. [PMID: 22032338 PMCID: PMC3219582 DOI: 10.1186/1532-429x-13-63] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022] Open
Abstract
Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick M Colletti
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
| | - Frank G Shellock
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
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36
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Nazarian S, Hansford R, Roguin A, Goldsher D, Zviman MM, Lardo AC, Caffo BS, Frick KD, Kraut MA, Kamel IR, Calkins H, Berger RD, Bluemke DA, Halperin HR. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med 2011; 155:415-24. [PMID: 21969340 PMCID: PMC4337840 DOI: 10.7326/0003-4819-155-7-201110040-00004] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. OBJECTIVE To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. DESIGN Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896) SETTING: One center in the United States (94% of examinations) and one in Israel. PATIENTS 438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. INTERVENTION Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachyarrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist. MEASUREMENTS Activation or inhibition of pacing, symptoms, and device variables. RESULTS In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, -0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, -2 Ω [IQR, -13 to 0 Ω], -4 Ω [IQR, -16 to 0 Ω], and -11 Ω [IQR, -40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, -1.1 to 0.3 mV]), decreased RV lead impedance (median, -3 Ω, [IQR, -29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, -0.01 V, IQR, -0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming. LIMITATIONS Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed. CONCLUSION With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential.
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Affiliation(s)
- Saman Nazarian
- Johns Hopkins University, Baltimore, Maryland 21287, USA.
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Buendia F, Cano O, Sanchez-Gomez JM, Igual B, Osca J, Sancho-Tello MJ, Olague J, Salvador A. Cardiac magnetic resonance imaging at 1.5 T in patients with cardiac rhythm devices. Europace 2011; 13:533-8. [DOI: 10.1093/europace/euq501] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Pavlović S, Milasinović G, Zivković M. Approach to patients with implanted pacemaker and scheduled surgical or diagnostic procedure. ACTA CHIRURGICA IUGOSLAVICA 2011; 58:25-29. [PMID: 21879647 DOI: 10.2298/aci1102025p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Application of cardiac electrostimulation in strictly defined indications has been on the increase over the last few decades. Frequent use of this therapy as well as the fact that it is applied predominantly in patients in the seventh decade of life, implies possible signifficant comorbidities and need for various diagnostic and surgical procedures. These are the reasons we decided to point out certain specific features in approaching this patient group in preparation and implementation of these procedures. Preoperative approach starts with usual patient history, with additional information on the type of pacemaker, last pacemaker check and electrocardiogram. This general approach is not substantialy different for pacemaker or ICD patients. What is specific is the possible interferrence caused by devices used in diagnostic or therapeutic procedures (diathermy, lithotripsy). Complications that may arise are usually related to the underlying disease rather than the pacemaker malfunction, but still, careful approach and pacemaker check are warranted, especially in the group marked as "pacemaker dependent". Adequate preoperative assessment, only slightly different from the usual, represents a sufficient guarantee for safe procedures diagnostic, therapeutic or surgical.
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Irnich W. Risks to pacemaker patients undergoing magnetic resonance imaging examinations. Europace 2010; 12:918-20. [DOI: 10.1093/europace/euq144] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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