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Harwood M, Fahrenholtz SJ, Wellnitz CV, Kawashima A, Panda A. MRI in Adult Patients with Active and Inactive Implanted MR-conditional, MR-nonconditional, and Other Devices. Radiographics 2024; 44:e230102. [PMID: 38421911 DOI: 10.1148/rg.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Active implanted medical devices (AIMDs) enable therapy and patient monitoring by way of electrical activity and typically have a battery and electrical leads. The most common types of AIMDs include cardiac implantable electronic devices (CIEDs), spinal cord stimulators, deep brain stimulators, bone growth or fusion stimulators, other neurostimulators, and drug infusion pumps. As more patients with AIMDs undergo MRI, it is important to consider the safety of patients who have these implanted devices during MRI. The authors review the physics concepts related to MRI safety, such as peak spatial gradient magnetic field, specific absorption rate, root mean square value of the effective magnetic component of the transmitted RF pulse, and gradient slew rate, as well as the parameters necessary to remain within safety limits. The roles of MRI safety personnel, as set forth by the International Society of Magnetic Resonance in Medicine, are emphasized. In addition, the relevant information provided in vendor manuals is reviewed, with a focus on how to obtain relevant up-to-date information. The radiologist should be able to modify protocols to meet safety requirements, address possible alternatives to MRI, and weigh the potential benefits of MRI against the potential risks. A few more advanced topics, such as fractured or abandoned device leads and patients with multiple implanted medical devices, also are addressed. Recommended workflows for MRI in patients with implanted medical devices are outlined. It is important to implement an algorithmic MRI safety process, including a review of the MRI safety information; patient screening; optimal imaging; and monitoring patients before, during, and after the examination. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Shetty et al in this issue.
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Affiliation(s)
- Matthew Harwood
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Samuel J Fahrenholtz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Clinton V Wellnitz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Akira Kawashima
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Anshuman Panda
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
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Joung B, Bae MH, Oh IY, Park HS, Shim J, Cho MS, Lee JM, Choi EK, Lee YS. Performance and Physician Experience of INGEVITY+ Active Fixation Leads: Prospective INGEVITY+ Lead Clinical Study in Korea. Cardiol Res Pract 2024; 2024:2172306. [PMID: 38239431 PMCID: PMC10796181 DOI: 10.1155/2024/2172306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
Background Boston Scientific INGEVITY+ pacing lead (Boston Scientific, Marlborough, MA, USA) has been upgraded to INGEVITY. The performance of the INGEVITY+ pacing lead has not yet been reported. This study aimed to evaluate the short- and long-term safety, effectiveness, and handling experience of INGEVITY+ leads. Methods Consecutive patients were included from 9 institutions in Korea, where 400 leads (200 right ventricular active fixation leads and 200 right atrial active fixation leads) were implanted or attempted in 200 subjects. Results During the implantation, only one patient required a lead change because of lead screw failure. The handling questionnaires of the lead received very positive feedback with 88% of operators agreeing that it is easy for leads to pass through small vessels or vessels with multiple leads. At the 3-month follow-up, 95.7% of RA leads and 99.5% of RV leads had pacing thresholds less than 1.5 V. A total of 92.4% of atrial leads had amplitudes greater than 1.5 mV, and 96.5% of ventricular leads had sensing amplitudes greater than 5 mV at 3 months. A total of 99.8% had impedances between 300 and 1,300 ohms. The lead-related complication-free rate for all leads during follow-up was 100%, and the overall rates of lead dislodgment, perforation, and pericardial effusion were all 0.0%. Conclusions The INGEVITY+ pacing lead exhibited exceptional clinical performance, with a high complication-free rate throughout the 3-month follow-up period. In addition, the lead displayed excellent electrical characteristics, and the lead-handling experience was reported to be very good.
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Affiliation(s)
- Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Myung Hwan Bae
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Il-Young Oh
- Seoul National University Bundang Hospital, Soengnam-Si, Republic of Korea
| | | | - Jaemin Shim
- Korea University Hospital, Seoul, Republic of Korea
| | - Min Soo Cho
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Eue-Keun Choi
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Soo Lee
- Daegu Catholic University Medical Center, Daegu, Republic of Korea
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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Minaskeian N, Hajnal SP, Liu MB, Klooster LM, Devick KL, Schwartz L, Jokerst CE, Sorajja D, Scott LRP. Safety of magnetic resonance imaging in patients with cardiac implantable electronic devices with generator and lead(s) brand mismatch. J Appl Clin Med Phys 2022; 23:e13520. [PMID: 35066975 PMCID: PMC8906220 DOI: 10.1002/acm2.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a valuable imaging modality for the assessment of both cardiac and non‐cardiac structures. With a growing population of patients with cardiovascular implantable electronic devices (CIEDs), 50%–75% of these patients will need an MRI. MRI‐conditional CIEDs have demonstrated safety of MRI scanning with such devices, yet non‐conditional devices such as hybrid CIEDs which have generator and lead brand mismatch may pose a safety risk. In this retrospective study, we examined the outcomes of patients with hybrid CIEDs undergoing MRI compared to those patients with non‐hybrid CIEDs. A total of 349 patients were included, of which 24 patients (7%) had hybrid CIEDs. The primary endpoint was the safety of MRI for patients with hybrid CIEDs as compared to those with non‐hybrid devices, measured by the rate of adverse events, including death, lead or generator failure needing immediate replacement, loss of capture, new onset arrhythmia, or power‐on reset. Secondary endpoints consisted of pre‐ and post‐MRI changes of decreased P‐wave or R‐wave sensing by ≥50%, changes in pacing lead impedance by ≥50 ohms, increase in pacing thresholds by ≥ 0.5 V at 0.4 ms, and decreasing battery voltage of ≥ 0.04 V. The primary endpoint of any adverse reaction was present in 1 (4.2%) patient with a hybrid device, and consistent of atrial tachyarrhythmia, and in 10 (3.1%) patients with a non‐hybrid device, and consisted of self‐limited atrial and non‐sustained ventricular arrhythmias; this was not statistically significant. No significant differences were found in the secondary endpoints. This study demonstrates that MRI in patients with hybrid CIEDs does not result in increased patient risk or significant device changes when compared to those patients who underwent MRI with non‐hybrid CIEDs.
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Affiliation(s)
- Nareg Minaskeian
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Sofia P Hajnal
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Michael B Liu
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Katrina L Devick
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Linda Schwartz
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Dan Sorajja
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Luis RP Scott
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
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Vuorinen AM, Paakkanen R, Karvonen J, Sinisalo J, Holmström M, Kivistö S, Peltonen JI, Kaasalainen T. Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads. Eur Radiol 2022; 32:3830-3838. [PMID: 34989847 DOI: 10.1007/s00330-021-08469-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The European Society of Cardiology Guidelines on cardiac pacing from 2021 allow magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) but do not recommend MRI in patients with epicardial pacing leads. The clinical dilemma remains whether performing an MRI in patients with CIED and epicardial leads is safe. We aimed to evaluate the safety of performing an MRI in patients with CIED and abandoned or functioning epicardial pacing leads. METHODS We included all adult patients who underwent clinically indicated MRIs with CIED and functioning or abandoned epicardial leads in a single tertiary hospital between November 2011 and October 2019. The data were retrospectively collected. RESULTS Twenty-six MRIs were performed on 17 patients with functioning or abandoned epicardial pacing leads. Sixty-nine percent of the MRI scans (18/26) were conducted on patients with functioning epicardial pacing leads. A definite adverse event occurred in one MRI scan. This was a transient elevation of the pacing threshold in a patient with a functioning epicardial ventricular pacing lead implanted 29 years previously. An irreversible atrial pacing lead impedance elevation was detected 6 months after the MRI in another patient; the association with the previous MRI remained unclear. No adverse events were detected in MRIs performed on patients with modern (implanted in 2000 or later) functioning epicardial leads. CONCLUSIONS MRIs in patients with CIED and modern functioning epicardial pacing leads were performed without detectable adverse events. Further large-scale studies are necessary to confirm MRI safety in patients with epicardial pacing leads. KEY POINTS • Currently, MRI in patients with cardiac implantable electronic devices (CIEDs) and functioning or abandoned epicardial pacing leads is not recommended. • MRIs in patients with CIED and modern functioning epicardial leads (implanted in 2000 or later) were performed without detectable adverse events in our patient cohort. • Allowing MRI in patients with epicardial pacing leads may significantly improve the diagnostic work-up, especially in specific patient groups, such as patients with congenital heart disease.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
| | - Riitta Paakkanen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha I Peltonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
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6
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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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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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Bauer WR, Lau DH, Wollmann C, McGavigan A, Mansourati J, Reiter T, Frömer S, Ladd ME, Quick HH. Clinical safety of ProMRI implantable cardioverter-defibrillator systems during head and lower lumbar magnetic resonance imaging at 1.5 Tesla. Sci Rep 2019; 9:18243. [PMID: 31796767 PMCID: PMC6890633 DOI: 10.1038/s41598-019-54342-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/05/2019] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) has long been contraindicated in patients with implanted pacemakers, defibrillators, and cardiac resynchronisation therapy (CRT) devices due to the risk of adverse effects through electromagnetic interference. Since many recipients of these devices will have a lifetime indication for an MRI scan, the implantable systems should be developed as ‘MRI-conditional’ (be safe for the MRI environment under predefined conditions). We evaluated the clinical safety of several Biotronik ProMRI (‘MRI-conditional’) defibrillator and CRT systems during head and lower lumbar MRI scans at 1.5 Tesla. The study enrolled 194 patients at 22 sites in Australia, Canada, and Europe. At ≥9 weeks after device implantation, predefined, non-diagnostic, specific absorption rate (SAR)-intensive head and lower lumbar MRI scans (total ≈30 minutes per patient) were performed in 146 patients that fulfilled pre-procedure criteria. Three primary endpoints were evaluated: freedom from serious adverse device effects (SADEs) related to MRI and defibrillator/CRT (leading to death, hospitalisation, life-threatening condition, or potentially requiring implanted system revision or replacement), pacing threshold increase, and sensing amplitude decrease, all at the 1-month post-MRI clinical visit. No MRI-related SADE occurred. Lead values remained stable, measured in clinic and monitored daily by the manufacturer home monitoring technology.
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Affiliation(s)
- Wolfgang Rudolf Bauer
- Department of Internal Medicine I, Universitätsklinikum Würzburg, Würzburg, Germany.
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christian Wollmann
- Department of Internal Medicine III, Universitätsklinikum St. Pölten, St. Pölten, Austria.,Institute of Cardiovascular Research, Karl-Landsteiner Society, St. Pölten, Austria
| | | | - Jacques Mansourati
- Hôpital de la Cavale Blanche, University Hospital of Brest and University of Western Brittany, Brest, France
| | - Theresa Reiter
- Department of Internal Medicine I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Simone Frömer
- Centre for Clinical Research, BIOTRONIK SE & Co. KG, Berlin, Germany
| | - Mark E Ladd
- Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany.,Erwin L. Hahn Institute for MR Imaging, University Duisburg-Essen, Essen, Germany
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Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned CIED. Neurosurg Rev 2019; 43:1539-1546. [PMID: 31624965 DOI: 10.1007/s10143-019-01149-6] [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: 02/14/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned cardiac implantable electrical devices (CIEDs) remains controversial. While a growing number of studies have shown safe employment in select patients under strict protocols, there is an increasing clinical need for further off-label investigations. To assess the feasibility and utility of brain MRI in neurological and neurosurgical patients with non-MRI-conditioned CIEDs using off-label protocol. We retrospectively evaluated 126 patients with non-MRI-conditioned CIEDs referred to our hospital between 2014 to 2018 for MRI under an IRB-approved protocol. A total of 126 off-label brain MRI scans were performed. The mean age was 67.5 ± 13.0. Seventy percent of scans were performed on female patients. Indications for MRI are neurosurgical (45.2%), neurological (51.6%), and others (3.2%). MRI utilization for tumor cases was highest for tumor cases (68.3%), but employment was valuable for vascular (12.7%), deep brain stimulators (3.2%), and other cases (15.9%). In the tumor category, (37.2%) of the scans were performed for initial diagnosis and pre-surgical planning, (47.7%) for post-intervention evaluation/surveillance, (15.1%) for stereotactic radiosurgery treatment (CyberKnife). No clinical complications were encountered. No functional device complications of the CIED were identified during and after the MRI in 96.9% of the studies. A 49.6% of the off-label brain MRI scans performed led to a clinically significant decision and/or intervention for the patients. A 42.9% of obtained MRI studies did not change the plan of care. A 7.9% of post-scan decision-making data was not available. We demonstrate that off-label brain MRI scans performed on select patients under a strict protocol is feasible, safe, and relevant. Almost 50% of scans provided critical information resulting in clinical intervention of the patients.
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Martinez JA, Ennis DB. MRI of Patients with Cardiac Implantable Electronic Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12. [DOI: 10.1007/s12410-019-9502-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Blessberger H, Kiblboeck D, Reiter C, Lambert T, Kellermair J, Schmit P, Fellner F, Lichtenauer M, Kypta A, Steinwender C, Kammler J. Monocenter Investigation Micra® MRI study (MIMICRY): feasibility study of the magnetic resonance imaging compatibility of a leadless pacemaker system. Europace 2018; 21:137-141. [DOI: 10.1093/europace/euy143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/27/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hermann Blessberger
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Daniel Kiblboeck
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Thomas Lambert
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
| | - Joerg Kellermair
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Pierre Schmit
- Central Radiology Institute, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Franz Fellner
- Central Radiology Institute, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
- Medical Faculty of the Friedrich Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Kypta
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
- Institute of Cardiovascular and Metabolic Research (ICMR), Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Juergen Kammler
- Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Krankenhausstr. 9, Linz, Austria
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13
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Kiblboeck D, Reiter C, Kammler J, Schmit P, Blessberger H, Kellermair J, Fellner F, Steinwender C. Artefacts in 1.5 Tesla and 3 Tesla cardiovascular magnetic resonance imaging in patients with leadless cardiac pacemakers. J Cardiovasc Magn Reson 2018; 20:47. [PMID: 29973228 PMCID: PMC6033226 DOI: 10.1186/s12968-018-0469-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging. The aim of this prospective, single-center, observational study was to evaluate artefacts on cardiovascular magnetic resonance (CMR) images in patients with LCP. METHODS Fifteen patients with Micra™ LCP, implanted at least 6 weeks prior to CMR scan, were enrolled and underwent either 1.5 Tesla or 3 Tesla CMR imaging. Artefacts were categorized into grade 1 (excellent image quality), grade 2 (good), grade 3 (poor) and grade 4 (non-diagnostic) for each myocardial segment. One patient was excluded because of an incomplete CMR investigation due to claustrophobia. RESULTS LCP caused an arc-shaped artefact (0.99 ± 0.16 cm2) at the right ventricular (RV) apex. Of 224 analyzed myocardial segments of the left ventricle (LV) 158 (70.5%) were affected by grade 1, 27 (12.1%) by grade 2, 17 (7.6%) by grade 3 and 22 (9.8%) by grade 4 artefacts. The artefact burden of grade 3 and 4 artefacts was significantly higher in the 3 Tesla group (3 Tesla vs 1.5 Tesla: 3.7 ± 1.6 vs 1.9 ± 1.4 myocardial segments per patient, p = 0.03). A high artefact burden was particularly observed in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV and in the mid and apical segments of the RV. Quantification of LV function and assessment of valves were feasible in all patients. We did not observe any clinical or device-related adverse events. CONCLUSION CMR imaging in patients with LCP is feasible with excellent to good image quality in the majority of LV segments. The artefact burden is comparable small allowing an accurate evaluation of LV function, cardiac structures and valves. However, artefacts in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV due to the LCP may impair or even exclude diagnostic evaluation of these segments. Artefacts on CMR images may be reduced by the use of 1.5 Tesla CMR scanners.
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Affiliation(s)
- Daniel Kiblboeck
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Juergen Kammler
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Pierre Schmit
- Department of Radiology, Kepler University Hospital Linz, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
| | - Franz Fellner
- Department of Radiology, Kepler University Hospital Linz, Linz, Austria
- Medical Faculty of the Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital Linz, Med Campus III, Krankenhausstraße 9, 4021 Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
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An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator. Eur Radiol 2018; 28:2406-2416. [PMID: 29318430 DOI: 10.1007/s00330-017-5098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). METHODS We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). RESULTS 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three-12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. CONCLUSIONS A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. KEY POINTS • Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers. • No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers. • Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic. • All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic. • Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.
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Nielsen JC, Giudici M, Tolasana Viu JM, Chew E, Sommerijns E, Wold N, Evert L, Love CJ, Stein K, Olaf H. Safety and effectiveness of a 6-French MRI conditional pacemaker lead: The INGEVITYTM
clinical investigation study results. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1121-1128. [DOI: 10.1111/pace.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Charles J. Love
- Cardiac Rhythm Device Services; Johns Hopkins Hospital; Baltimore MD USA
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GIMBEL JROD. Off-Label MRI in 2017 of CIEDs: A Daily “Fork-in-the Road” for Implanters and the Case for Common Sense. Pacing Clin Electrophysiol 2017; 40:463-466. [DOI: 10.1111/pace.13056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- J. ROD GIMBEL
- Columbia-St. Mary's Hospital; Cardiology; Milwaukee Wisconsin
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