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Meier C, Israel C, Eisenblätter M, Hoyer A, Stoye FV, Yilmaz A, Gielen S. Safety of magnetic resonance imaging in patients with cardiac implantable electronic devices and abandoned or epicardial leads: a systematic review and meta-analysis. Europace 2024; 26:euae165. [PMID: 38918179 PMCID: PMC11200101 DOI: 10.1093/europace/euae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
AIMS Persistent reluctance to perform magnetic resonance imaging (MRI) in patients with abandoned and/or epicardial leads of cardiac implantable electronic devices is related to in vitro studies reporting tip heating. While there is a plethora of data on the safety of MRI in conditional and non-conditional implantable devices, there is a clear lack of safety data in patients with abandoned and/or epicardial leads. METHODS AND RESULTS Relevant literature was identified in Medline and CINAHL using the key terms 'magnetic resonance imaging' AND 'abandoned leads' OR 'epicardial leads'. Secondary literature and cross-references were supplemented. For reporting guidance, the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 was used. International Prospective Register of Systematic Reviews (PROSPERO) registration number 465530. Twenty-one publications with a total of 656 patients with 854 abandoned and/or epicardial leads and 929 MRI scans of different anatomical regions were included. No scan-related major adverse cardiac event was documented, although the possibility of under-reporting of critical events in the literature should be considered. Furthermore, no severe device dysfunction or severe arrhythmia was reported. Mainly transient lead parameter changes were observed in 2.8% in the subgroup of patients with functional epicardial leads. As a possible correlate of myocardial affection, subjective sensations occurred mainly in the subgroup with abandoned epicardial leads (4.0%), but no change in myocardial biomarkers was observed. CONCLUSION Existing publications did not report any relevant adverse events for MRI in patients with abandoned and/or epicardial leads if performed according to strict safety guidelines. However, a more rigorous risk-benefit calculation should be made for patients with epicardial leads.
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Affiliation(s)
- Claudia Meier
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Röntgenstraße 18, 32756 Detmold, Germany
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
| | - Carsten Israel
- Klinik für Innere Medizin, Kardiologie, Nephrologie und Diabetologie, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Michel Eisenblätter
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsinstitut für Diagnostische und Interventionelle Radiologie, Detmold, Germany
| | - Annika Hoyer
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Institut für Biostatistik und Medizinische Biometrie, Universität Bielefeld, Bielefeld, Germany
| | - Ferdinand Valentin Stoye
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Institut für Biostatistik und Medizinische Biometrie, Universität Bielefeld, Bielefeld, Germany
| | - Ali Yilmaz
- Herz-MRT-Zentrum, Universitätsklinikum Münster, Münster, Germany
| | - Stephan Gielen
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Röntgenstraße 18, 32756 Detmold, Germany
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
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Deneke T, Kutyifa V, Hindricks G, Sommer P, Zeppenfeld K, Carbucicchio C, Pürerfellner H, Heinzel FR, Traykov VB, De Riva M, Pontone G, Lehmkuhl L, Haugaa K. Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology. Europace 2024; 26:euae108. [PMID: 38743765 PMCID: PMC11104536 DOI: 10.1093/europace/euae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.
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Affiliation(s)
- Thomas Deneke
- Clinic for Rhythmology at Klinikum Nürnberg Campus Süd, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Helmut Pürerfellner
- Department of Clinical Electrophysiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Frank R Heinzel
- Städtisches Klinikum Dresden, Department of Cardiology, Angiology and Intensive Care Medicine, Dresden, Germany
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Marta De Riva
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lukas Lehmkuhl
- Department of Radiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Germany
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3
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 371] [Impact Index Per Article: 371.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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4
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Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
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Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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5
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Natale A, Zeppenfeld K, Della Bella P, Liu X, Sabbag A, Santangeli P, Sommer P, Sticherling C, Zhang X, Di Biase L. Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward. Europace 2023; 25:euad225. [PMID: 37622589 PMCID: PMC10451002 DOI: 10.1093/europace/euad225] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/26/2023] Open
Abstract
This article will discuss the past, present, and future of ventricular tachycardia ablation and the continuing contribution of the Europace journal as the platform for publication of milestone research papers in this field of ventricular tachycardia ablation.
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Affiliation(s)
- Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - Xu Liu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Avi Sabbag
- Sheba Medical Center, Tel HaShomer, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Philipp Sommer
- Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Xiaodong Zhang
- Montefiore Health System, Einstein Medical School, New York, USA
| | - Luigi Di Biase
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
- Montefiore Health System, Einstein Medical School, New York, USA
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6
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Ra J, Oberdier MT, Suzuki M, Vaidya D, Liu Y, Hansford R, McVeigh D, Weltin V, Tao S, Thiemann DR, Nazarian S, Halperin HR. Implantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance Imaging. Ann Intern Med 2023; 176:289-297. [PMID: 36716451 DOI: 10.7326/m22-2653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies have shown that magnetic resonance imaging (MRI) does not have clinically important effects on the device parameters of non-MRI-conditional implantable cardioverter-defibrillators (ICDs). However, data on non-MRI-conditional ICD detection and treatment of arrhythmias after MRI are limited. OBJECTIVE To examine if non-MRI-conditional ICDs have preserved shock function of arrhythmias after MRI. DESIGN Prospective cohort study. (ClinicalTrials.gov: NCT01130896). SETTING 1 center in the United States. PATIENTS 629 patients with non-MRI-conditional ICDs enrolled consecutively between February 2003 and January 2015. INTERVENTIONS 813 total MRI examinations at a magnetic field strength of 1.5 Tesla using a prespecified safety protocol. MEASUREMENTS Implantable cardioverter-defibrillator interrogations were collected after MRI. Clinical outcomes included arrhythmia detection and treatment, generator or lead exchanges, adverse events, and death. RESULTS During a median follow-up of 2.2 years from MRI to latest available ICD interrogation before generator or lead exchange in 536 patients, 4177 arrhythmia episodes were detected, and 97 patients received ICD shocks. Sixty-one patients (10% of total) had 130 spontaneous ventricular tachycardia or fibrillation events terminated by ICD shocks. A total of 210 patients (33% of total) are known to have died (median, 1.7 years from MRI to death); 3 had cardiac arrhythmia deaths where shocks were indicated without direct evidence of device dysfunction. LIMITATIONS Data were acquired at a single center and may not be generalizable to other clinical settings and MRI facilities. Implantable cardioverter-defibrillator interrogations were not available for a subset of patients; adjudication of cause of death relied solely on death certificate data in a subset. CONCLUSION Non-MRI-conditional ICDs appropriately treated detected tachyarrhythmias after MRI. No serious adverse effects on device function were reported after MRI. PRIMARY FUNDING SOURCE Johns Hopkins University and National Institutes of Health.
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Affiliation(s)
- Joshua Ra
- Department of Medicine, University of California San Francisco, San Francisco, California (J.R.)
| | - Matt T Oberdier
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Masahito Suzuki
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Dhananjay Vaidya
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Yisi Liu
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland (Y.L.)
| | - Rozann Hansford
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Diana McVeigh
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Valeria Weltin
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Susumu Tao
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - David R Thiemann
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Saman Nazarian
- Department of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (S.N.)
| | - Henry R Halperin
- Department of Cardiology and Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland (H.R.H.)
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7
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Hilbert S, Hindricks G. [Cardiovascular magnetic resonance imaging in patients with cardiac devices : Useful tool or just artifacts?]. Herzschrittmacherther Elektrophysiol 2022; 33:278-282. [PMID: 35781832 DOI: 10.1007/s00399-022-00873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Cardiac magnetic resonance tomography (CMR) in patients with implanted cardiac devices is a challenge. This is due to artifacts that can occur in the presence of metallic implants such as device leads and generators and can ultimately lead to impaired or non-diagnostic images. Preliminary studies indicate that by employing newly developed MRI sequences together with well-established sequences, these problems can be mitigated. To aid in daily routine, an adaptive imaging workflow has been proposed which allows for tailored image acquisition.
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Affiliation(s)
- Sebastian Hilbert
- Abteilung Rhythmologie, Herzzentrum Leipzig, Universitätsklinik für Kardiologie - Helios Stiftungsprofessur, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Gerhard Hindricks
- Abteilung Rhythmologie, Herzzentrum Leipzig, Universitätsklinik für Kardiologie - Helios Stiftungsprofessur, Strümpellstr. 39, 04289, Leipzig, Deutschland
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8
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Kuroda K, Yatsushiro S. New Insights into MR Safety for Implantable Medical Devices. Magn Reson Med Sci 2022; 21:110-131. [PMID: 35228487 PMCID: PMC9199981 DOI: 10.2463/mrms.rev.2021-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/08/2022] [Indexed: 12/24/2022] Open
Abstract
Over the last two decades, the status of MR safety has dramatically changed. In particular, ever since the MR-conditional cardiac device was approved by the Food and Drug Administration (FDA) in 2008 and by the Pharmaceuticals and Medical Devices Agency (PMDA) in 2012, the safety of patients with an implantable medical device (IMD) has been one of the most important issues in terms of MR use. In conjunction with the regulatory approvals for various IMDs, standards, technical specifications, and guidelines have also been rapidly created and developed. Many invaluable papers investigating and reviewing the history and status of MR use in the presence of IMDs already exist. As such, this review paper seeks to bridge the gap between clinical practice and the information that is obtained by standard-based tests and provided by an IMD's package insert or instructions for use. Interpretation of the gradient of the magnetic flux density intensity of the static magnetic field with respect to the magnetic displacement force is discussed, along with the physical background of RF field. The relationship between specific absorption rate (SAR) and B1+RMS, and their effects on image quality are described. In addition, insofar as providing new directions for future research and practice, the feasibility of safety test methods for RF-induced heating of IMDs using MR thermometry, evaluation of tissue heat damage, and challenges in cardiac IMDs will be discussed.
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Affiliation(s)
- Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Satoshi Yatsushiro
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
- Biosim Laboratory, Bioview, Inc., Tokyo, Japan
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9
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Orini M, Seraphim A, Graham A, Bhuva A, Zacur E, Kellman P, Schilling R, Hunter R, Dhinoja M, Finlay MC, Ahsan S, Chow AW, Moon JC, Lambiase PD, Manisty C. Detailed Assessment of Low-Voltage Zones Localization by Cardiac MRI in Patients With Implantable Devices. JACC Clin Electrophysiol 2022; 8:225-235. [PMID: 35210080 DOI: 10.1016/j.jacep.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the performance and limitations of low-voltage zones (LVZ) localization by optimized late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) scar imaging in patients with cardiac implantable electronic devices (CIEDs). BACKGROUND Scar evaluation by LGE-CMR can assist ventricular tachycardia (VT) ablation, but challenges with electroanatomical maps coregistration and presence of imaging artefacts from CIED limit accuracy. METHODS A total of 10 patients underwent VT ablation and preprocedural LGE-CMR using wideband imaging. Scar was segmented from CMR pixel signal intensity maps using commercial software (ADAS-VT, Galgo Medical) with bespoke tools and compared with detailed electroanatomical maps (CARTO). Coregistration of EP and imaging-derived scar was performed using the aorta as a fiducial marker, and the impact of coregistration was determined by assessing intraobserver/interobserver variability and using computer simulations. Spatial smoothing was applied to assess correlation at different spatial resolutions and to reduce noise. RESULTS Pixel signal intensity maps localized low-voltage zones (V <1.5 mV) with area under the receiver-operating characteristic curve: 0.82 (interquartile range [IQR]: 0.76-0.83), sensitivity 74% (IQR: 71%-77%), and specificity 78% (IQR: 73%-83%) and correlated with bipolar voltage (r = -0.57 [IQR: -0.68 to -0.42]) across patients. In simulations, small random shifts and rotations worsened LVZ localization in at least some cases. The use of the full aortic geometry ensured high reproducibility of LVZ localization (r >0.86 for area under the receiver-operating characteristic curve). Spatial smoothing improved localization of LVZ. Results for LVZ with V <0.5 mV were similar. CONCLUSIONS In patients with CIEDs, novel wideband CMR sequences and personalized coregistration strategies can localize LVZ with good accuracy and may assist VT ablation procedures.
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Affiliation(s)
- Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Adam Graham
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anish Bhuva
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ernesto Zacur
- Department of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Peter Kellman
- National Institutes of Health, Bethesda, Maryland, USA
| | - Richard Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross Hunter
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mehul Dhinoja
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm C Finlay
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Syed Ahsan
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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10
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Is diversity harmful?-Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging. Wien Klin Wochenschr 2021; 134:286-293. [PMID: 34402991 PMCID: PMC9023390 DOI: 10.1007/s00508-021-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
Background Many patients with cardiac implantable electronic devices (CIED) undergo magnetic resonance imaging (MRI); however, a relevant proportion have a CIED system that has not been classified as MRI-conditional because of generators and leads from different brands (mixed-brand group). The available data concerning the outcome of these mixed patients undergoing MRI is limited. Methods A retrospective single center study, including all patients with CIEDs undergoing MRI between January 2013 until May 2020, was performed. Primary endpoints were defined as death or any adverse event necessitating hospitalization or CIED revision. Secondary endpoints were the occurrence of any sign for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with 1–9 MRIs per patient. Of the patients 38 underwent 54 procedures in the mixed-brand group and 89 patients underwent 134 MRIs in the MRI-conditional group. Of the patients 31 were excluded since the MRI conditionality could not be determined. No primary endpoints occurred within the mixed-brand group but in 2.2% of the MRI-conditional group (p = 1.000), with 2 patients developing new atrial fibrillation during MRI, of whom one additionally had a transient CIED dysfunction. No secondary endpoints were met in the mixed-brand group compared to 3.4% in the MRI-conditional group (p = 0.554). No complications occurred in the excluded patients. Conclusion The complication rate of CIED patients undergoing MRI was low. Patients with a mixed CIED system showed no signs of increased risk of adverse events compared to patients with MRI-conditional CIED systems. Supplementary Information The online version of this article (10.1007/s00508-021-01924-w) contains supplementary material, which is available to authorized users.
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11
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Sohns C, Sommer P. Magnetic resonance imaging in all patients with implanted cardiac devices - Yes, We Can! Int J Cardiol 2021; 338:274-275. [PMID: 34118323 DOI: 10.1016/j.ijcard.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
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12
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Singh A, Chen W, Patel HN, Alvi N, Kawaji K, Besser SA, Tung R, Zou J, Lang RM, Mor-Avi V, Patel AR. Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device-Related Artifacts in Different Implantable Cardioverter-Defibrillator Types. J Magn Reson Imaging 2021; 54:1257-1265. [PMID: 33742522 DOI: 10.1002/jmri.27608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter-defibrillators (ICD) is limited by device-related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with different ICD types is not well known. PURPOSE To assess the effects of WB LGE imaging on DRA in different non-MR conditional ICD subtypes. STUDY TYPE Retrospective. POPULATION A total of 113 patients undergoing cardiac magnetic resonance imaging with three ICD subtypes: transvenous (TV-ICD, N = 48), cardiac-resynchronization therapy device (CRT-D, N = 48), and subcutaneous (S-ICD, N = 17). FIELD STRENGTH/SEQUENCE 5 T scanner, standard LGE, and WB LGE imaging with a phase-sensitive inversion recovery segmented gradient echo sequence. ASSESSMENT DRA burden was defined as the number of artifact-positive short-axis LGE slices as percentage of the total number of short-axis slices covering the left ventricle from based to apex, and was determined for WB and standard LGE studies for each patient. Additionally, artifact area on each slice was quantified. STATISTICAL TESTS Shapiro-Wilks, Kruskal-Wallis analysis of variance, Dunn tests with Bonferroni correction, and Mann-Whitney U-test. RESULTS In patients with TV-ICD, DRA burden was significantly reduced and nearly eliminated with WB LGE compared to standard LGE imaging (median [interquartile range]: 0 [0-7]% vs. 18 [0-50]%, P < 0.05), but WB imaging had less of an impact on DRA in the CRT-D (8 [0-23]% vs. 16 [0-45]%, p = 0.12) and S-ICD (60 [15-71]% vs. 67 [50-92]%, P = 0.09) patients. Residual DRA was significantly greater (P < 0.05) for S-ICD compared to other device types with WB LGE imaging, despite the generators of all three ICD types having similar proximity to the heart. The area of S-ICD associated DRA was smaller with WB LGE (P < 0.001) than with standard LGE imaging and the artifacts had different characteristics (dark signal void instead of a bright hyperenhancement artifact). DATA CONCLUSION Although WB LGE imaging reduced the burden of DRA caused by S-ICD, the residual artifact was greater than that observed with TV-ICD and CRT-D devices. Further developments are needed to better resolve S-ICD artifacts. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: STAGE: 5.
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Affiliation(s)
- Amita Singh
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Wensu Chen
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA.,Cardiology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hena N Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Keigo Kawaji
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Stephanie A Besser
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jiangang Zou
- Cardiology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Victor Mor-Avi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
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Deshpande S, Kella D, Padmanabhan D. MRI in patients with cardiac implantable electronic devices: A comprehensive review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:360-372. [DOI: 10.1111/pace.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Danesh Kella
- Department of Cardiology Piedmont Heart Institute Atlanta Georgia USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
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14
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Mascioli G, Lucca E, Michelotti F, Tarantino L, Giofré F, Finamora I. Need for MRI scans in a real-world CIED population over long-term follow-up: Data from a large single-centre experience. PLoS One 2020; 15:e0244672. [PMID: 33378333 PMCID: PMC7773230 DOI: 10.1371/journal.pone.0244672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Giosuè Mascioli
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Elena Lucca
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Luca Tarantino
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Fabrizio Giofré
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Ilaria Finamora
- Division of Electrophisiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
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15
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Ning X, Li X, Fan X, Chen K, Hua W, Liu Z, Dai Y, Chen X, Lu M, Zhao S, Zhang S. 3.0 T magnetic resonance imaging scanning on different body regions in patients with pacemakers. J Interv Card Electrophysiol 2020; 61:545-550. [PMID: 32808082 DOI: 10.1007/s10840-020-00854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers. METHODS Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists. RESULTS Twenty-three MRI scans of different body regions (brain = 13, lumbar spine = 4, cervical spine = 2, and heart = 4) were performed, and the average time of a scan was 25 ± 11 min. No significant changes in sensing amplitude (atrial 3.1 ± 1.1 mV vs. 2.9 ± 1.2 mV, P = 0.71; ventricular 9.3 ± 3.5 mV vs. 10.2 ± 3.4 mV, P = 0.46), lead impedances (atrial 647 ± 146 Ω vs. 627 ± 151 Ω, P = 0.7; ventricular: 780 ± 247 Ω vs.711 ± 226 Ω, P = 0.36), or pacing threshold (atrial 0.6 ± 0.2 V/0.4 ms vs. 0.6 ± 0.2 V/0.4 ms, P = 0.71; ventricular 0.7 ± 0.3 V/0.4 ms vs. 0.7 ± 0.2 V/0.4 ms, P = 0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value. CONCLUSION Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.
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Affiliation(s)
- Xiaohui Ning
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaofei Li
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiaohan Fan
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China.
| | - Keping Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Zhimin Liu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Yan Dai
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shihua Zhao
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
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16
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Abstract
OBJECTIVE. Patients with cardiac implantable electronic devices (CIEDs) require cardiac MRI (CMRI) for a variety of reasons. The purpose of this study is to review and evaluate the value and safety of CMRI for patients with in situ CIEDs. CONCLUSION. Late gadolinium enhancement CMRI is the reference standard for assessing myocardial viability in patients with ventricular tachycardia before ablation of arrhythmogenic substrates. The use of late gadolinium enhancement CMRI for patients with CIEDs is safe as long as an imaging protocol is in place and precaution measures are taken.
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17
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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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