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Zhou M, Kourtiche D, Claudel J, Deschamps F, Magne I, Roth P, Schmitt P, Nadi M. Interference voltage measurement and analysis of cardiac implants exposed to electric fields at extremely low frequency. Biomed Phys Eng Express 2024; 10:045060. [PMID: 38861945 DOI: 10.1088/2057-1976/ad567e] [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: 04/08/2024] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
Objective.The possibility of interference by electromagnetic fields in the workplaces with cardiac implants is a concern for both individuals and employers. This article presents an analysis of the interference to which cardiac implants are subjected under high-intensity electric field at the power frequency.Approach.Evaluations of interference were conducted by studying the induced voltages at the device input in the real case study and the substitute study, and establishing an association between them with the equivalence factorF. A funnel-shaped phantom, designed forin vitrotesting and representing the electrical characteristics of the locations where cardiac implants are installed, was used in the substitute study. A measuring system was implemented to measure the induced voltage at the device input under high intensity electric fields.Main results.The induced voltages obtained in the experimental measurements align with the findings of the numerical study in the phantom. By applying the equivalence factors derived between the real case study and the substitute study (2.39 for unipolar sensing; 3.64 for bipolar sensing), the induced voltages on the cardiac implants can be determined for the real case using the substitute experimental set-up.Significance.The interference voltages on the cardiac implants under electric field exposures at low frequency were experimentally measured with detailed description. The findings provide evidence for an analysis method to systematically study the electromagnetic interference on the cardiac implants at low frequency.
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Affiliation(s)
- Mengxi Zhou
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
| | - Djilali Kourtiche
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
| | - Julien Claudel
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
| | - Francois Deschamps
- RTE, Direction Développement Ingénierie, Département Concertation et Environnement, Place du Dôme 92073 Paris La Défense Cedex, France
| | - Isabelle Magne
- EDF , Service des Etudes Médicales, Immeuble Smartside, Bâtiment Bréchet, 4ème étage, zone 4-680 4 rue Floréal, 75017 Paris, France
| | - Patrice Roth
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
| | - Pierre Schmitt
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
| | - Mustapha Nadi
- Université de Lorraine, Institut Jean Lamour (UMR 7198), CNRS, 2 allée André Guinier, Campus Artem, 54000 Nancy, France
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Gut P, Cochet H, Caluori G, El-Hamrani D, Constantin M, Vlachos K, Sridi S, Antiochos P, Schwitter J, Masi A, Sacher F, Jaïs P, Stuber M, Bustin A. Wideband black-blood late gadolinium enhancement imaging for improved myocardial scar assessment in patients with cardiac implantable electronic devices. Magn Reson Med 2024. [PMID: 38852175 DOI: 10.1002/mrm.30162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Wideband phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) enables myocardial scar imaging in implantable cardioverter defibrillators (ICD) patients, mitigating hyperintensity artifacts. To address subendocardial scar visibility challenges, a 2D breath-hold single-shot electrocardiography-triggered black-blood (BB) LGE sequence was integrated with wideband imaging, enhancing scar-blood contrast. METHODS Wideband BB, with increased bandwidth in the inversion pulse (0.8-3.8 kHz) and T2 preparation refocusing pulses (1.6-5.0 kHz), was compared with conventional and wideband PSIR, and conventional BB, in a phantom and sheep with and without ICD, and in six patients with cardiac devices and known myocardial injury. ICD artifact extent was quantified in the phantom and specific absorption rate (SAR) was reported for each sequence. Image contrast ratios were analyzed in both phantom and animal experiments. Expert radiologists assessed image quality, artifact severity, and scar segments in patients and sheep. Additionally, histology was performed on the sheep's heart. RESULTS In the phantom, wideband BB reduced ICD artifacts by 62% compared to conventional BB while substantially improving scar-blood contrast, but with a SAR more than 24 times that of wideband PSIR. Similarly, the animal study demonstrated a considerable increase in scar-blood contrast with wideband BB, with superior scar detection compared with wideband PSIR, the latter confirmed by histology. In alignment with the animal study, wideband BB successfully eliminated severe ICD hyperintensity artifacts in all patients, surpassing wideband PSIR in image quality and scar detection. CONCLUSION Wideband BB may play a crucial role in imaging ICD patients, offering images with reduced ICD artifacts and enhanced scar detection.
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Affiliation(s)
- Pauline Gut
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Dounia El-Hamrani
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Marion Constantin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Konstantinos Vlachos
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Soumaya Sridi
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Panagiotis Antiochos
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jürg Schwitter
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ambra Masi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Pierre Jaïs
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Aurélien Bustin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- Hôpital Xavier Arnozan, Pessac, France
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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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Bhuva A, Charles-Edwards G, Ashmore J, Lipton A, Benbow M, Grainger D, Lobban T, Gopalan D, Slade A, Roditi G, Manisty C. Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices. Heart 2024; 110:e3. [PMID: 36104218 DOI: 10.1136/heartjnl-2022-320810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.
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Affiliation(s)
- Anish Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Geoff Charles-Edwards
- Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Representative for the British Institute of Radiology, London, UK
| | - Jonathan Ashmore
- Department of Medical Physics and Bioengineering, NHS Highland, Inverness, UK
- Representative for Institute of Physics and Engineering in Medicine, York, UK
| | | | - Matthew Benbow
- Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
- Representative for British Association of MR Radiographers, Sheffield, UK
| | - David Grainger
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Trudie Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford upon Avon, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College London, London, UK
- Representative for Royal College of Radiologists, London, UK
| | - Alistair Slade
- Cardiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Representative for British Heart Rhythm Society, Chipping Norton, UK
| | - Giles Roditi
- Radiology, Glasgow Royal Infirmary, Glasgow, UK
- Representative of the British Society of Cardiovascular Imaging and British Society of Cardiovascular CT, London, UK
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Representative of British Cardiovascular Society, London, UK
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Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 PMCID: PMC11211236 DOI: 10.1016/j.jocmr.2024.100995] [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: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
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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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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [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: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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Chakrabarti AK, Deshmukh A, Liang JJ, Madamanchi C, Ghannam M, Morady F, Bogun F. Mitral Annular Substrate and Ventricular Arrhythmias in Arrhythmogenic Mitral Valve Prolapse With Mitral Annular Disjunction. JACC Clin Electrophysiol 2023; 9:1265-1275. [PMID: 37086231 DOI: 10.1016/j.jacep.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND In patients with bileaflet mitral valve prolapse (MVP), mitral annular disjunction (MAD) is associated with increased risk of sudden cardiac death via incompletely understood mechanisms. OBJECTIVES This study assessed the substrate for ventricular arrhythmias in patients with bileaflet MVP and MAD as well as outcomes of catheter ablation with an emphasis on sustained, monomorphic ventricular tachycardia (VT). METHODS A total of 18 consecutive patients (11 women, mean age 54 ± 15 years) with bileaflet MVP and MAD underwent catheter ablation for VT, and/or premature ventricular complexes (PVCs). Eight patients had a prior cardiac arrest. RESULTS PVCs were targeted for ablation in all 18 patients (symptomatic PVCs n = 15, PVC-induced ventricular fibrillation n = 3). Sustained monomorphic VT was targeted in 7 of 18 patients. Electroanatomic mapping showed low voltage in the area of the mitral annulus corresponding to VT target sites in 6 of 7 patients with sustained VT. Four of 7 patients had low voltage in the areas of MAD. Six of 7 patients with VT were rendered noninducible post-ablation. The PVC burden was reduced from 11.0% ± 10.4% to 4.0% ± 5.5% (P = 0.004). Over a mean follow-up of 33.9 ± 43.4 months, no VTs recurred. There were no major complications. No repeat ablations for VT occurred. Five of 18 patients required repeat ablation for PVCs. CONCLUSIONS In patients with bileaflet MVP and MAD undergoing catheter ablation, the mitral valve annulus often contains low-voltage areas harboring the substrate for monomorphic VT and PVCs. Ablation in these patients was safe and improved arrhythmia control.
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Affiliation(s)
- Apurba K Chakrabarti
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amrish Deshmukh
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson J Liang
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaitanya Madamanchi
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Do Y, Ahn SH, Kim S, Kim JK, Choi BW, Kim H, Lee YH. Detection of Pacemaker and Identification of MRI-conditional Pacemaker Based on Deep-learning Convolutional Neural Networks to Improve Patient Safety. J Med Syst 2023; 47:80. [PMID: 37522981 DOI: 10.1007/s10916-023-01981-w] [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: 10/06/2022] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
With the increased availability of magnetic resonance imaging (MRI) and a progressive rise in the frequency of cardiac device implantation, there is an increased chance that patients with implanted cardiac devices require MRI examination during their lifetime. Though MRI is generally contraindicated in patients who have undergone pacemaker implantation with electronic circuits, the recent introduction of MR Conditional pacemaker allows physicians to take advantage of MRI to assess these patients during diagnosis and treatment. When MRI examinations of patients with pacemaker are requested, physicians must confirm whether the device is a conventional pacemaker or an MR Conditional pacemaker by reviewing chest radiographs or the electronic medical records (EMRs). The purpose of this study was to evaluate the utility of a deep convolutional neural network (DCNN) trained to detect pacemakers on chest radiographs and to determine the device's subclassification. The DCNN perfectly detected pacemakers on chest radiographs and the accuracy of the subclassification of pacemakers using the internal and external test datasets were 100.0% (n = 106/106) and 90.1% (n = 279/308). The DCNN can be applied to the radiologic workflow for double-checking purposes, thereby improving patient safety during MRI and preventing busy physicians from making errors.
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Affiliation(s)
- Yoonah Do
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Ho Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
- Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei- ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sungjun Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyem Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hwiyoung Kim
- Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei- ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
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10
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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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11
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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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12
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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13
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Shah R, Sharma A, Assis F, De Vasconcellos HD, Alugubelli N, Pandey P, Akhtar T, Gasperetti A, Zhou S, Halperin H, Zimmerman SL, Tandri H, Kolandaivelu A. Quality assessment of cardiac magnetic resonance myocardial scar imaging prior to ventricular arrhythmia ablation. Int J Cardiovasc Imaging 2023; 39:411-421. [PMID: 36331683 PMCID: PMC9870828 DOI: 10.1007/s10554-022-02734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.
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Affiliation(s)
- Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Fabrizio Assis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Henrique Doria De Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Navya Alugubelli
- Division of Cardiology, Department of Medicine, Creighton University, Omaha, NE USA
| | - Pallavi Pandey
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Tauseef Akhtar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Shijie Zhou
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH USA ,Department of Electrical and Chemical Engineering, Miami University, Oxford, OH USA
| | - Henry Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
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Magnetic resonance imaging in patients with cardiac implantable electronic devices: A prospective study. Magn Reson Imaging 2022; 91:9-15. [DOI: 10.1016/j.mri.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 05/01/2022] [Indexed: 11/20/2022]
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15
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Siddamsetti S, Shinn A, Gautam S. Remote Programming of Cardiac Implantable Electronic Devices: A Novel Approach to Program Cardiac Devices for Magnetic Resonance Imaging. J Cardiovasc Electrophysiol 2022; 33:1005-1009. [PMID: 35243710 DOI: 10.1111/jce.15434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic Resonance imaging (MRI) in patients with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIEDs in patients undergoing MRI scan. METHODS We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from the 2090 Medtronic programmer over the CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 patients who underwent RP of CIEDs for MRI. Outcomes analyzed were successful completion of RP sessions and time saved per scan. RESULTS Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any patient. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Time saved per scan was estimated to be 28 +/-10 minutes. CONCLUSIONS Remote programming of CIEDs for MRI scans is a safe and effective strategy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sisir Siddamsetti
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Alexander Shinn
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
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16
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Hong S, Hong K, Culver AE, Pathrose A, Allen BD, Wilcox JE, Lee DC, Kim D. Highly Accelerated Real-Time Free-Breathing Cine CMR for Patients With a Cardiac Implantable Electronic Device. Acad Radiol 2021; 28:1779-1786. [PMID: 32888766 DOI: 10.1016/j.acra.2020.07.041] [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: 06/15/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a 16-fold accelerated real-time, free-breathing cine cardiovascular magnetic resonance (CMR) pulse sequence with compressed sensing reconstruction and test whether it is capable of producing clinically acceptable summed visual scores (SVS) and accurate left ventricular ejection fraction (LVEF) in patients with a cardiac implantable electronic device (CIED). MATERIALS AND METHODS A 16-fold accelerated real-time cine CMR pulse sequence was developed using gradient echo readout, Cartesian k-space sampling, and compressed sensing. We scanned 13 CIED patients (mean age = 59 years; 9/4 males/females) using clinical standard, breath-hold cine and real-time, free-breathing cine. Two clinical readers performed a visual assessment of image quality in four categories (conspicuity of endocardial wall at end diastole, temporal fidelity of wall motion, any artifact level on the heart, noise) using a five-point Likert scale (1: worst; 3: clinically acceptable; 5: best). SVS was calculated as the sum of 4 individual scores, where 12 was defined as clinical acceptable. The Wilcoxon signed-rank test was performed to compare SVS, and the Bland-Altman analysis was conducted to evaluate the agreement of LVEF. RESULTS Median scan time was 3.7 times shorter for real-time (3.5 heartbeats per slice) than clinical standard (13 heartbeats per slice, excluding nonscanning time between successive breath-hold acquisitions). Median SVS was not significantly different between clinical standard (15.0) and real-time (14.5). The mean difference in LVEF was -2% (4.7% of mean), and the limits of agreement was 5.8% (13.5% of mean). CONCLUSION This study demonstrates that the proposed real-time cine method produces clinically acceptable SVS and relatively accurate LVEF in CIED patients.
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Yang E, Suzuki M, Nazarian S, Halperin H. Magnetic Resonance Imaging Safety in Patients with Cardiac Implantable Electronic Devices. Trends Cardiovasc Med 2021; 32:440-447. [PMID: 34384880 DOI: 10.1016/j.tcm.2021.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
High strength magnetic and electric fields used in magnetic resonance imaging (MRI) render images with unmatched soft tissue contrast. These imaging attributes have made MRI an increasingly preferred diagnostic tool in many medical conditions. Initially there was substantial concern regarding the safety of performing these imaging studies in patients with cardiac implantable electronic devices (CIEDs), which have the potential to be affected by the intense electric and magnetic fields of the MRI. More recently, there has been increasing evidence that MRI can be performed safely in patients with devices that have not been specifically labelled by regulatory agencies for use in an MRI environment (MRI nonconditional devices), which has allowed the Centers for Medicare and Medicaid Services (CMS) to start providing reimbursement for MRIs of patients with MRI nonconditional devices. For CMS to reimburse scans, a rigorous protocol must be followed, which recognizes that there are still potential adverse effects that can be mitigated by appropriate procedures. In this review we will survey the initial experiences and efforts to understand the magnitude of risk for device malfunction and harm, as well as current efforts to minimize the potential risks of MRI effects on devices and leads (heating, device movement, lead dislodgement, and device malfunction, the latter including inhibition of pacing and generation of arrhythmias).
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Affiliation(s)
- Eunice Yang
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD
| | - Masahito Suzuki
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD
| | - Saman Nazarian
- University of Pennsylvania, Division of Cardiology, Philadelphia, PA
| | - Henry Halperin
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD; Johns Hopkins University, Departments of Radiology and Biomedical Engineering.
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Lee EM, Ibrahim ESH, Dudek N, Lu JC, Kalia V, Runge M, Srinivasan A, Stojanovska J, Agarwal PP. Improving MR Image Quality in Patients with Metallic Implants. Radiographics 2021; 41:E126-E137. [PMID: 34143712 DOI: 10.1148/rg.2021200092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The number of implanted devices such as orthopedic hardware and cardiac implantable devices continues to increase with an increase in the age of the patient population, as well as an increase in the number of indications for specific devices. Many patients with these devices have or will develop clinical conditions that are best depicted at MRI. However, implanted devices containing paramagnetic or ferromagnetic substances can cause significant artifact, which could limit the diagnostic capability of this modality. Performing imaging with MRI when an implant is present may be challenging, and there are numerous techniques the radiologist and technologist can use to help minimize artifacts related to implants. First, knowledge of the presence of an implant before patient arrival is critical to ensure safety of the patient when the device is subjected to a strong magnetic field. Once safety is ensured, the examination should be performed with the MRI system that is expected to provide the best image quality. The selection of the MRI system includes multiple considerations such as the effects of field strength and availability of specific sequences, which can reduce metal artifact. Appropriate patient positioning, attention to MRI parameters (including bandwidth, voxel size, and echo), and appropriate selection of sequences (those with less metal artifact and advanced metal reduction sequences) are critical to improve image quality. Patients with implants can be successfully imaged with MRI with appropriate planning and understanding of how to minimize artifacts. This improves image quality and the diagnostic confidence of the radiologist. ©RSNA, 2021.
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Affiliation(s)
- Elizabeth M Lee
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - El-Sayed H Ibrahim
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Nancy Dudek
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jimmy C Lu
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Vivek Kalia
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Mason Runge
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Ashok Srinivasan
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jadranka Stojanovska
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Prachi P Agarwal
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
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20
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Ian Paterson D, White JA, Butler CR, Connelly KA, Guerra PG, Hill MD, James MT, Kirpalani A, Lydell CP, Roifman I, Sarak B, Sterns LD, Verma A, Wan D, Crean AM, Grosse-Wortmann L, Hanneman K, Leipsic J, Manlucu J, Nguyen ET, Sandhu RK, Villemaire C, Wald RM, Windram J. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol 2021; 37:835-847. [PMID: 34154798 DOI: 10.1016/j.cjca.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
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Affiliation(s)
| | - D Ian Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - James A White
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Guerra
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Michael D Hill
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anish Kirpalani
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carmen P Lydell
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley Sarak
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Elsie T Nguyen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Villemaire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rachel M Wald
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Windram
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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21
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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22
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Mangini F, Samar H, Gevenosky L, Williams RB, Shah M, Doyle M, Yamrozik JA, Lombardi R, Bonnet CA, Mansour A, Biederman RWW. Where do we go from here? Beyond the MagnaSafe trial: A focus beyond a 'safety-first' notion. An MRI study in 500 consecutive patients. Int J Cardiol 2021; 336:113-120. [PMID: 34029619 DOI: 10.1016/j.ijcard.2021.05.031] [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: 02/28/2021] [Revised: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND In patients with conventional pacemakers or ICD's, MRI is infrequently performed due to safety concerns. Recent reports have allayed many of these concerns. However, the additive clinical value of scanning patients with cardiac implants has not been established. OBJECTIVE Assessing the additive value of thoracic and non-thoracic MRI in patients with implantable cardiac devices. METHODS AND RESULTS Prospective data were analyzed in 500 patients with implanted cardiac devices that underwent MRI over a 12 year period at a single institution (Allegheny General Hospital, Pittsburgh, PA). A set of three questions were answered following scan interpretation by both the MRI technologist and interpreting MRI physician(s): 1) Did the primary diagnosis change? 2) Did MRI provide additional information to the existing diagnosis? 3) Did patient management change? If 'Yes' was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or guiding therapy. Scans encountered were neurological/neurosurgical 354 (70.8%), cardiac 98 (19.6%) and orthopedic 48 (9.6%) in nature. In 431 (86%) MRI added additional information to the primary diagnosis and in 277 (55.4%) MRI changed the primary diagnosis. In 304 (60.8%) cases management changed, 265 (53%) due to a change in diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered and no adverse effects of MRI scan were noted. CONCLUSIONS MRI in patients with implanted cardiac devices was of additive value to diagnosis and management thereby informing risk-benefit considerations. CONDENSED ABSTRACT 500 patients with implanted cardiac devices who underwent a MRI examination over a 12 year period were followed prospectively. Imaging primarily focus on three anatomical regions (neurological/neurosurgical, cardiac and orthopedic) providing added information to the primary diagnosis in 431 (86%) cases and changing the primary diagnosis in 277 (55.4%) cases. In 304 (60.8%) cases management changed with 265 (53%) being due to a change of diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered using a defined protocol. CONCLUSIONS MR imaging retains its diagnostic yield in patients with implanted devices.
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Affiliation(s)
- Francesco Mangini
- Cardiovascular Unit, "Dario Camberlingo" Hospital, ASL Br, Francavilla Fontana (Br), Italy - Cardiac MRI Unit - "Di Summa - Perrino" Hospital, ASL BR, Brindisi, Italy.
| | - Huma Samar
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Loma Linda Veterans Affairs Hospital, Benton Street, Loma Linda, CA, USA.
| | - Loretta Gevenosky
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Ronald B Williams
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Moneal Shah
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Mark Doyle
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - June A Yamrozik
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Richard Lombardi
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Christopher A Bonnet
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA; Division of Electrophysiology, Cardiovascular Institute, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Anas Mansour
- Eastern Maine Medical Center, 302 Husson Ave, Bangor, ME, USA.
| | - Robert W W Biederman
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
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23
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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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24
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Nguyen TD, Sandberg SA, Durrani AK, Mitchell KW, Keith MD, Gleva MJ, Woodard PK. The cumulative effects and clinical safety of repeat magnetic resonance imaging on an MRI-conditional pacemaker system at 1.5 tesla. Heart Rhythm O2 2020; 2:73-79. [PMID: 34113907 PMCID: PMC8183850 DOI: 10.1016/j.hroo.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background Studies have demonstrated magnetic resonance imaging (MRI) safety in the presence of MRI-conditional permanent pacemakers (PPM). However, since patients' care may require serial MRIs, it is necessary to evaluate device safety and performance after multiple scans. Objectives We evaluated safety and performance of MRI-conditional PPMs after serial MRIs over various anatomic regions performed during a multicenter, prospective, single-arm study (ProMRI). Methods ProMRI was a multiphase observational study designed to evaluate PPM performance after MRI scans. Our study evaluated PPM function in a cohort of patients who underwent multiple 1.5-T MRI scans. Selected patients underwent separate head, chest, and lumbar spine MRIs. Pacing capture threshold (PCT), lead impedance (LI), sensing amplitude, and battery capacity were collected before and after scanning. Freedom from serious adverse device effects (SADE) through 1 month post MRI served as a primary endpoint. Changes in PPM function parameters, including threshold success rate and sensing attenuation, were analyzed for statistical significance and clinical relevance. Results In 81 patients no adverse events or SADE occurred. Statistically significant changes in ventricular PCT (0.034 ± 0.15 V) immediately after, ventricular LI immediately after (-18.7 ± 44.2 Ω) and 1 month post phase B (-19.8 ± 44.9 Ω), and atrial sensing attenuation immediately after (-0.27 ± 0.92 mV) and 1 month post phase B (-0.22 ± 0.92 mV) were noted. However, these changes were not clinically relevant in degree. Conclusion These results demonstrate the safety and performance of the ProMRI PPM in patients undergoing 3 serial MRIs over various anatomic regions.
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Affiliation(s)
- Thuy D Nguyen
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Sarah A Sandberg
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri.,Brookwood Baptist Health, Birmingham, Alabama
| | - Amir K Durrani
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri.,Division of Cardiovascular Medicine, Washington Permanente, Seattle, Washington
| | - Kevin W Mitchell
- Clinical Studies Division at Biotronik, Inc, Lake Oswego, Oregon
| | - Matthew D Keith
- Clinical Studies Division at Biotronik, Inc, Lake Oswego, Oregon
| | - Marye J Gleva
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Pamela K Woodard
- Divisions of Cardiovascular Medicine and Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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25
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Schwartz SM, Pathrose A, Serhal AM, Ragin AB, Charron J, Knight BP, Passman RS, Avery RJ, Kim D. Evaluation of image quality of wideband single-shot late gadolinium-enhancement MRI in patients with a cardiac implantable electronic device. J Cardiovasc Electrophysiol 2020; 32:138-147. [PMID: 33146422 DOI: 10.1111/jce.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While wideband segmented, breath-hold late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) has been shown to suppress image artifacts associated with cardiac-implanted electronic devices (CIEDs), it may produce image artifacts in patients with arrhythmia and/or dyspnea. Single-shot LGE is capable of suppressing said artifacts. We sought to compare the performance of wideband single-shot free-breathing LGE against the standard and wideband-segmented LGEs in CIED patients. METHODS AND RESULTS We retrospectively identified all 54 consecutive patients (mean age: 61 ± 15 years; 31% females) with CIED who had undergone CMR with standard segmented, wideband segmented, and/or wideband single-shot LGE sequences as part of quality assurance for determining best clinical practice at 1.5 T. Two raters independently graded the conspicuity of myocardial scar or normal myocardium and the presence of device artifact level on a 5-point Likert scale (1: worst; 3: acceptable; 5: best). Summed visual score (SVS) was calculated as the sum of conspicuity and artifact scores (SVS ≥ 6 defined as diagnostically interpretable). Median conspicuity and artifact scores were significantly better for wideband single-shot LGE (F = 24.2, p < .001) and wideband-segmented LGE (F = 20.6, p < .001) compared to standard-segmented LGE. Among evaluated myocardial segments, 72% were deemed diagnostically interpretable-defined as SVS ≥ 6-for standard-segmented LGE, 89% were deemed diagnostically interpretable for wideband-segmented LGE, and 94% segments were deemed diagnostically interpretable for wideband single-shot LGE. CONCLUSIONS Wideband single-shot LGE and wideband-segmented LGE produced similarly improved image quality compared to standard LGE.
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Affiliation(s)
- Sarah M Schwartz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali M Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann B Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Charron
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley P Knight
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan J Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gupta SK, Ya'qoub L, Wimmer AP, Fisher S, Saeed IM. Safety and Clinical Impact of MRI in Patients with Non-MRI-conditional Cardiac Devices. Radiol Cardiothorac Imaging 2020; 2:e200086. [PMID: 33778621 DOI: 10.1148/ryct.2020200086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/11/2022]
Abstract
Purpose To explore the safety and clinical utility of MRI in participants with non-MRI-conditional cardiac implantable electronic devices, by establishing the Patient Registry of Magnetic Resonance Imaging in Non-Approved DEvices (PROMeNADe). Materials and Methods From September 2015 to June 2019, 532 participants (211 women) with a mean age of 69 years ± 14 (standard deviation) were enrolled prospectively in the PROMeNADe registry (ClinicalTrials.gov identifier: NCT03081364) and underwent a total of 608 MRI examinations (61 cardiac MRI examinations). All participants had device interrogations performed before and after each MRI. Pacemaker-dependent patients received asynchronous pacing. Patients with an implantable cardioverter defibrillator (ICD) had tachycardia therapies disabled during the MRI. An electrophysiology nurse monitored participants for any hemodynamic or rhythm abnormalities. Referring physicians were surveyed regarding the clinical utility of the MRI. Standard descriptive analyses included summary statistics with percentages and means. Results Cardiac devices included pacemakers (46%), ICDs (30%), cardiac resynchronization therapy (CRT) pacemakers (4%), and CRT defibrillators (17%), as well as abandoned leads (2%). Pacemaker-dependent patients comprised 27% of all MRI examinations. There were no patient- or device-related complications. Clinical utility surveys of MRI examinations were completed by 150 physicians. According to the survey responses, these MRI examinations changed the suspected diagnosis 25% of the time and changed suspected prognosis in 26% of participants, with planned medical or surgical treatment being changed 42% of the time. Conclusion This registry demonstrates that MRI examinations, including thoracic MRI examinations, can be performed safely in patients who have non-MRI-conditional devices, in pacemaker-dependent patients with ICDs, and in patients with abandoned leads. These MRI examinations can have a substantial impact on patient care, justifying the extensive resources used to perform them.Supplemental material is available for this article.© RSNA, 2020See also the commentary by Peshock in this issue.
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Affiliation(s)
- Sanjaya K Gupta
- Departments of Cardiology (S.K.G., A.P.W., I.M.S.) and Neurology (S.F.), Saint Luke's Mid-America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111; University of Missouri-Kansas City, Kansas City, Mo (S.K.G., A.P.W., S.F., I.M.S.); Department of Cardiology, Ochsner-Louisiana State University, Shreveport, La (L.Y.); and Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, Mo (S.F.)
| | - Lina Ya'qoub
- Departments of Cardiology (S.K.G., A.P.W., I.M.S.) and Neurology (S.F.), Saint Luke's Mid-America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111; University of Missouri-Kansas City, Kansas City, Mo (S.K.G., A.P.W., S.F., I.M.S.); Department of Cardiology, Ochsner-Louisiana State University, Shreveport, La (L.Y.); and Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, Mo (S.F.)
| | - Alan P Wimmer
- Departments of Cardiology (S.K.G., A.P.W., I.M.S.) and Neurology (S.F.), Saint Luke's Mid-America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111; University of Missouri-Kansas City, Kansas City, Mo (S.K.G., A.P.W., S.F., I.M.S.); Department of Cardiology, Ochsner-Louisiana State University, Shreveport, La (L.Y.); and Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, Mo (S.F.)
| | - Stanley Fisher
- Departments of Cardiology (S.K.G., A.P.W., I.M.S.) and Neurology (S.F.), Saint Luke's Mid-America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111; University of Missouri-Kansas City, Kansas City, Mo (S.K.G., A.P.W., S.F., I.M.S.); Department of Cardiology, Ochsner-Louisiana State University, Shreveport, La (L.Y.); and Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, Mo (S.F.)
| | - Ibrahim M Saeed
- Departments of Cardiology (S.K.G., A.P.W., I.M.S.) and Neurology (S.F.), Saint Luke's Mid-America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111; University of Missouri-Kansas City, Kansas City, Mo (S.K.G., A.P.W., S.F., I.M.S.); Department of Cardiology, Ochsner-Louisiana State University, Shreveport, La (L.Y.); and Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, Mo (S.F.)
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Ryan JW, Murray AS, Gilligan PJ, Bisset JM, Nolan C, Doyle A, Emerson B, Galvin JM, Murray JG. MRI safety management in patients with cardiac implantable electronic devices: Utilizing failure mode and effects analysis for risk optimization. Int J Qual Health Care 2020; 32:431-437. [PMID: 32578847 DOI: 10.1093/intqhc/mzaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/13/2020] [Accepted: 06/20/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Cardiac implantable electronic devices (CIEDs) are increasing in prevalence. Exposing patients with CIEDs to magnetic resonance imaging (MRI) can lead to adverse outcomes. This has led certain radiology departments to not accept MRI referrals related to patients with CIEDs. Patients with MR-conditional CIEDs can be safely scanned under specific conditions. Our institution has accepted such referrals since 2014. The aim of this study was to systematically identify and reduce risk in our CIED-MRI protocol using failure mode and effects analysis (FMEA). METHODS A multidisciplinary FMEA team was assembled and included senior stakeholders from the CIED-MRI protocol. A process map was constructed followed by risk analysis and scoring. Targeted interventions were formulated and implemented; high-risk failure modes were prioritized. A new process map and protocol were drafted and repeat risk analysis was performed. Monitoring and re-evaluation of the CIED-MRI pathway were instigated at departmental quality assurance (QA) meetings. RESULTS Interventions included direct CIED characterization using wireless technology pre-MRI, CIED programming and reprogramming in the MRI suite before and immediately after MRI reducing device downtime and continuous patient monitoring during MRI by a cardiac physiologist. The cumulative risk priority number (RPN) decreased from 1190 pre-FMEA to 492 post-FMEA. DISCUSSION Despite the risk of exposing CIEDs to the MR environment, patients with MR-conditional CIEDs can be safely scanned with an appropriate multidisciplinary support. We found FMEA an indispensable tool in identifying and minimizing risk with no adverse events recorded since FMEA recommendations were implemented.
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Affiliation(s)
- James W Ryan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | | | | | - Chris Nolan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Audrey Doyle
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Barry Emerson
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | - John G Murray
- Mater Private Hospital, Eccles Street, Dublin, Ireland
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Browne JE, Tiegs-Heiden CA, Lehman VT, Long Z, Hangiandreou NJ, Watson RE, Hesley GK, Gorny KR. Magnetic Resonance Imaging–Guided Focused Ultrasound Ablation of Lumbar Facet Joints of a Patient With a Magnetic Resonance Image Non-Conditional Pacemaker at 1.5T. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:464-468. [PMID: 32793874 PMCID: PMC7411156 DOI: 10.1016/j.mayocpiqo.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Patient and Methods Results Conclusion
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Lindemann F, Oebel S, Paetsch I, Arya A, Dagres N, Richter S, Dinov B, Hilbert S, Loebe S, Stegmann C, Doering M, Bollmann A, Hindricks G, Jahnke C. Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms. J Cardiovasc Magn Reson 2020; 22:32. [PMID: 32389126 PMCID: PMC7212569 DOI: 10.1186/s12968-020-00609-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).
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Affiliation(s)
- Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Susanne Loebe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Clara Stegmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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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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An operational approach to the execution of MR examinations in patients with CIED. Radiol Med 2020; 125:1311-1321. [PMID: 32367321 DOI: 10.1007/s11547-020-01206-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
In the context of the increasing spread of cardiac active implantable heart devices (CIEDs) in the population and of the wide diagnostic/therapeutic utility of magnetic resonance (MRI) examinations, the goal of this paper is to provide the experience of the Santa Maria Nuova Hospital of the USL Tuscany Center in Florence and to report an organizational proposal to perform, in the hospital settings, MRI examinations on patients carrying CIED. This report is intended to show the operational choices of a Radiology Department which organizes this activity in accordance with the new Italian regulatory framework in the field of safety of MR sites (Ministero della Salute in Decreto Ministeriale 10 agosto 2018 Determinazione degli standard di sicurezza e impiego per le apparecchiature a risonanza magnetica, 2018).
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Rahsepar AA, Zimmerman SL, Hansford R, Guttman MA, Castro V, McVeigh D, Kirsch JE, Halperin HR, Nazarian S. The Relationship between MRI Radiofrequency Energy and Function of Nonconditional Implanted Cardiac Devices: A Prospective Evaluation. Radiology 2020; 295:307-313. [PMID: 32125255 PMCID: PMC7193917 DOI: 10.1148/radiol.2020191132] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022]
Abstract
Background The risks associated with MRI in individuals who have implanted cardiac devices are thought to arise from the interaction between the implanted device and static, gradient, and radiofrequency magnetic fields. Purpose To determine the relationship between the peak whole-body averaged specific absorption rate (SAR) and change in magnetic field per unit time (dB/dt), maximum specific energy dose, imaging region, and implanted cardiac device characteristics and their function in patients undergoing MRI. Materials and Methods This prospective observational cohort study was conducted from October 16, 2003, to January 22, 2015 (https://ClinicalTrials.gov, NCT01130896). Any individual with an implanted cardiac device who was referred for MRI was included. Clinical MRI protocols without SAR restriction were used. Exclusion criteria were newly implanted leads, abandoned or epicardial leads, and dependence on a pacemaker with an implantable cardioverter defibrillator without asynchronous pacing capability. For each MRI pulse sequence, the calculated whole-body values for SAR, dB/dt, and scan duration were collected. Atrial and ventricular sensing, lead impedance, and capture threshold were evaluated before and immediately after (within 10 minutes) completion of each MRI examination. Generalized estimating equations with Gaussian family, identity link, and an exchangeable working correlation matrix were used for statistical analysis. Results A total of 2028 MRI examinations were performed in 1464 study participants with 2755 device leads (mean age, 67 years ± 15 [standard deviation]; 930 men [64%]). There was no evidence of an association between radiofrequency energy deposition, dB/dt, or scan duration and changes in device parameters. Thoracic MRI was associated with decreased battery voltage immediately after MRI (β = -0.008 V, P < .001). Additionally, right ventricular (RV) lead length was associated with decreased RV sensing (β = -0.012 mV, P = .05) and reduced RV capture threshold (β = -0.002 V, P < .01) immediately after MRI. Conclusion There was no evidence of an association between MRI parameters that characterize patient exposure to radiofrequency energy and changes in device and lead parameters immediately after MRI. Nevertheless, device interrogation before and after MRI remains mandatory due to the potential for device reset and changes in lead or generator parameters. © RSNA, 2020 See also the editorial by Shellock in this issue.
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Affiliation(s)
- Amir Ali Rahsepar
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Stefan L. Zimmerman
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Rozann Hansford
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Michael A. Guttman
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Valeria Castro
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Diana McVeigh
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - John E. Kirsch
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Henry R. Halperin
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
| | - Saman Nazarian
- From the Department of Medicine, Division of Cardiology (A.A.R.,
R.H., M.A.G., V.C., D.M., H.R.H., S.N.), and Russell H. Morgan Department of
Radiology and Radiological Science (S.L.Z.), Johns Hopkins University, School of
Medicine, Baltimore, MD; Department of Radiology, Division of Cardiovascular
Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Ill
(A.A.R.); Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (J.E.K.); and Department
of Medicine, Division of Cardiology, University of Pennsylvania, Perelman School
of Medicine, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104
(S.N.)
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Hong K, Collins JD, Freed BH, Fan L, Arai AE, Hsu LY, Lee DC, Kim D. Accelerated Wideband Myocardial Perfusion Pulse Sequence with Compressed Sensing Reconstruction for Myocardial Blood Flow Quantification in Patients with a Cardiac Implantable Electronic Device. Radiol Cardiothorac Imaging 2020; 2:e190114. [PMID: 32420548 DOI: 10.1148/ryct.2020190114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
Purpose To develop an accelerated wideband cardiac perfusion pulse sequence and test whether it can produce diagnostically acceptable image quality and whether it can be used to reliably quantify myocardial blood flow (MBF) in patients with a cardiac implantable electronic device (CIED). Materials and Methods A fivefold-accelerated wideband perfusion pulse sequence was developed using compressed sensing to sample one arterial input function plane and three myocardial perfusion (MP) planes per heartbeat in patients with a CIED with heart rates as high as 102 beats per minute. Resting perfusion scans were performed in 10 patients with a CIED and in 10 patients with no device as a control group. Two clinical readers compared the resulting images and retrospective images of the 10 patients with a CIED, which were obtained by using a previously described twofold-accelerated wideband perfusion pulse sequence with temporal generalized autocalibrating partially parallel acquisition. Summed visual score (SVS) was defined as the sum of conspicuity, artifact, and noise scores individually ranging from 1 (worst) to 5 (best). Resting MBF in the remote zones was quantified using Fermi deconvolution. Results Median SVS was significantly different (P < .05) between the prospective and retrospective CIED groups (13 vs nine) and between the nondevice group and the retrospective CIED group (13.5 vs nine); all median SVSs were nine or greater (clinically acceptable cut point). The median resting MBF in remote zones was not significantly different (P = .27) between patients with a CIED (1.1 mL/min/g; median left ventricular ejection fraction [LVEF], 52.5%) and patients with no device (1.3 mL/min/g; median LVEF, 64.0%). Mean MBF values were consistent with those (mean resting MBF range, 1.0-1.2 mL/min/g) reported by two prior state-of-the-art cardiac perfusion MRI studies. Conclusion The proposed scan yielded diagnostically acceptable image quality and enabled reliable quantification of MBF with three MP planes per heartbeat in patients with a CIED with heart rates as high as 102 beats per minute. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- KyungPyo Hong
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Jeremy D Collins
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Benjamin H Freed
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Lexiaozi Fan
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Andrew E Arai
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Li-Yueh Hsu
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Daniel C Lee
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Daniel Kim
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
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Shellock FG. MRI and Patients with Non-MRI-conditional Cardiac Devices: Further Evidence of Safety. Radiology 2020; 295:314-315. [PMID: 32129708 DOI: 10.1148/radiol.2020200217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frank G Shellock
- From the Department of Radiology and Medicine, University of Southern California, Keck School of Medicine, 7751 Veragua Dr, Playa Del Rey, CA 90293
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Han D, Lee JH, Oh IY, Chae IH, Lee HY, Cho Y. Automatic consultation system for patients with cardiac implantable electronic devices undergoing magnetic resonance imaging. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-019-0010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safety evaluation for patients with cardiac implantable electronic devices (CIEDs) undergoing magnetic resonance imaging (MRI) scanning is often overlooked. We developed an automatic consultation system (ACS) to improve the screening rate in these patients.
Methods
ACS was developed by the Hospital Information System Development Department of Seoul National University Bundang Hospital. It was designed to automatically request pre-MRI cardiac evaluation in patients with CIED when MRI orders are issued. The proportion of the patients without pre-MRI cardiologic evaluation was evaluated before and after the ACS application.
Results
From January 2016 to June 2018, a total of 157 patients with CIEDs [pacemaker 136 (86.6%), ICD or CRT-D 21 (13.4%), MR-conditional 117 (74.5%)] visited the MRI facility. Before the ACS application, 23 out of 84 patients (27.4%) did not have adequate pre-MRI cardiologic evaluation. Despite urgent request for pre-MRI cardiac evaluation, MRI examination was postponed or cancelled in 14 (60.8%) cases. After the ACS application, all 73 patients underwent proper cardiologic evaluation before their MRI examinations (P < 0.001). The proportion of immediate request for pre-MRI evaluation at the moment of MRI order also improved with the ACS application (before ACS 57.1%, after ACS 100%, P < 0.001).
Conclusions
The newly developed ACS helped the patients with CIED receive MRI scan safely on the schedule, improving the quality of care in this population.
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Kułach A, Skowerski T, Gąsior Z. Repeated magnetic resonance imaging and Cyberknife therapy for Parkinson's disease in a patient with a pacemaker and epicardial leads. Arch Med Sci 2020; 16:1470-1471. [PMID: 33224351 PMCID: PMC7667442 DOI: 10.5114/aoms.2020.100308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/05/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Andrzej Kułach
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Tomasz Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Chaudhry U, Svensson J, Mosén H, Mörtsell D. Cardiac magnetic resonance imaging in a patient with temporary external pacemaker: a case report. Eur Heart J Case Rep 2019; 3:1-4. [PMID: 31911995 PMCID: PMC6939813 DOI: 10.1093/ehjcr/ytz228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/05/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
Background Magnetic resonance imaging (MRI) is increasingly becoming the imaging modality of choice for many clinical disorders due to superior image quality and absence of radiation. However, access to MRI remains limited for most patients with cardiac implantable electronic devices due to potential safety concerns. In line with guidelines, there is no absolute contraindication to perform MRI, but warrants careful risk-benefit assessment. Case summary A 59-year-old man was admitted with a 5-day history of central chest pain and few week’s history of general malaise, dry cough, and breathlessness. Electrocardiogram confirmed complete atrioventricular block (CAVB). A slight increase in cardiac enzyme was noted. Coronary angiogram revealed atheromatous changes, but no obstructive coronary lesion. A temporary transvenous pacemaker was inserted. Transthoracic echocardiogram confirmed a dilated left ventricle with severely reduced left ventricular function. To facilitate diagnosis (hence prognosis), management and mobilization, investigation with cardiovascular magnetic resonance (CMR) was warranted but contraindicated by the temporary transvenous pacemaker. An active fixation pacemaker lead was therefore placed in the right ventricle via percutaneous puncture of the right subclavian vein and connected to a pulse generator, both secured to the skin with sutures and adhesive medical dressing. Appropriate device programming and close patient monitoring ensured that CMR could be performed without any adverse effects. A diagnosis of acute myocarditis was confirmed. Regular device interrogation during an extended 3-week period with temporary pacing ruled out any device failure. As there was no resolution of CAVB, the patient received a dual-chamber pacemaker. Discussion Cardiovascular magnetic resonance was feasible and safely performed on a patient with a temporary permanent external pacemaker system using a standard screw-in pacing lead and a regular pulse generator fixed to the skin. Although more studies are needed for generalizability, CMR may be used in highly selected patients with a temporary pacemaker.
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Affiliation(s)
- Uzma Chaudhry
- Department of Cardiology, Clinical Sciences, Lund University, Arrhythmia Clinic, Skåne University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, J Waldenströms gata 35, Malmö S-205 02, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Henrik Mosén
- Department of Clinical Physiology, Clinical Sciences, Lund University, Skåne University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - David Mörtsell
- Department of Cardiology, Clinical Sciences, Lund University, Arrhythmia Clinic, Skåne University Hospital, Getingevägen, Lund S-221 85, Sweden
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Bhuva AN, Moralee R, Moon JC, Manisty CH. Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. Eur Radiol 2019; 30:1378-1384. [PMID: 31776746 PMCID: PMC7033076 DOI: 10.1007/s00330-019-06449-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.
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Affiliation(s)
- A N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute for Cardiovascular Science, University College London, London, UK.
| | - R Moralee
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - J C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
| | - C H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
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Vuorinen AM, Pakarinen S, Jaakkola I, Holmström M, Kivistö S, Kaasalainen T. Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population. Acta Radiol 2019; 60:1414-1421. [PMID: 30781967 DOI: 10.1177/0284185119830288] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Magnetic resonance imaging (MRI) in patients with cardiac pacing devices has become available despite previously being considered absolutely contraindicated. However, most institutional safety protocols have included several limitations on patient selection, leaving MRI unavailable for many patients. Purpose To evaluate the first 1000 MRI examinations conducted on patients with cardiac pacing devices at Helsinki University Hospital for any potential safety hazards and also to evaluate the long-term functionality of the safety protocol in “real-life” clinical practice. Material and Methods A total of 1000 clinically indicated MRI scans were performed with a 1.5-T MRI scanner according to the safety protocol. The following information was collected from the electronic medical record (EMR): patients’ date of birth; sex; pacing device generator model; date of MRI scan; date of the latest pacing device generator implantation; and the body region scanned. The EMR of these patients was checked and especially searched for any pacing device related safety hazards or adverse outcomes during or after the MRI scan. Results Only one potentially dangerous adverse event was noted in our study group. In addition, patients with abandoned leads, temporary pacing devices, and newly implanted pacing device generators were scanned successfully and safely. Conclusion MRI scans can be performed safely in patients with cardiac pacing devices if the dedicated safety protocol is followed.
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Affiliation(s)
- Aino-Maija Vuorinen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Pakarinen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Jaakkola
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Kivistö
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Grewal SS, Gorny KR, Favazza CP, Watson RE, Kaufmann TJ, Van Gompel JJ. Safety of Laser Interstitial Thermal Therapy in Patients With Pacemakers. Oper Neurosurg (Hagerstown) 2019; 15:E69-E72. [PMID: 29444267 DOI: 10.1093/ons/opx292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Laser interstitial thermal therapy (LiTT) has increasingly been used as a treatment option for medically refractory epilepsy, tumors, and radiation necrosis. The use of LiTT requires intraoperative magnetic resonance (MR) thermography. This can become an issue in patients with other implanted therapeutic devices such as pacemakers and vagal nerve stimulators due to concerns regarding increases in the specific absorption rate (SAR). This is a technical case report demonstrating a successfully and safely performed LiTT in a 1.5-T magnetic resonance imaging (MRI) in a patient with a pacemaker for mesial temporal sclerosis. CLINICAL PRESENTATION An 83-yr-old gentleman who had an implanted cardiac pacemaker presented with medically intractable epilepsy and was confirmed to have mesial temporal sclerosis on imaging. Video electroencephalography demonstrated concordant ipsilateral seizures and semiology. He underwent LiTT for ablation of the mesial temporal lobe. This was performed with the below described protocol with a cardiology nurse monitoring the patient's cardiac condition and a physicist monitoring SAR, and MR imaging quality without any adverse events. CONCLUSION This study reports on a protocol of cardiac and MR SAR to safely perform MR-guided LiTT in the setting of traditional pacemakers in patients who are not pacemaker dependent.
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Affiliation(s)
- Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
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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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Bhuva AN, Feuchter P, Hawkins A, Cash L, Boubertakh R, Evanson J, Schilling R, Lowe M, Moon JC, Manisty CH. MRI for patients with cardiac implantable electronic devices: simplifying complexity with a 'one-stop' service model. BMJ Qual Saf 2019; 28:853-858. [PMID: 30760606 PMCID: PMC6837254 DOI: 10.1136/bmjqs-2018-009079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist. AIM To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs). METHODS Patients requested a 'one-stop' service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this 'one-stop' service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed. RESULTS 215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation. CONCLUSION Implementation of a 'one-stop' service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.
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Affiliation(s)
- Anish N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Patricia Feuchter
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Angela Hawkins
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Lizette Cash
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Redha Boubertakh
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Jane Evanson
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Richard Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Martin Lowe
- Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Charlotte H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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Metal Artifact Reduction in Cardiovascular MRI for Accurate Myocardial Scar Assessment in Patients With Cardiac Implantable Electronic Devices. AJR Am J Roentgenol 2019; 213:555-561. [DOI: 10.2214/ajr.19.21187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Martinez JA, Serano P, Ennis DB. Patient Orientation Affects Lead-Tip Heating of Cardiac Active Implantable Medical Devices during MRI. Radiol Cardiothorac Imaging 2019; 1:e190006. [PMID: 32076667 DOI: 10.1148/ryct.2019190006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate changes in patient orientation to mitigate radiofrequency-induced lead-tip heating (LTH) during MRI. Materials and Methods LTH was evaluated for device type, lead path, and distance to the isocenter of a 1.5-T MRI system. LTH for 378 conditions in both head-first (HF) and feet-first (FF) orientations was measured for nine MRI-unsafe cardiac active implantable medical devices (AIMDs) placed along three (two anatomic, one planar) left-sided lead paths at nine landmark locations. The devices were exposed to 5 minutes of continuous radiofrequency energy at 4 W/kg whole-body specific absorption rate. Results LTH was greater in HF than in FF orientation for the planar and one anatomic lead path (P < .05). LTH was significantly affected by lead path, distance to isocenter, and patient orientation (all P < .05), but not by cardiac AIMD device type. Maximum LTH was observed in an HF orientation for the planar lead path when the lead tip was at isocenter (right ventricular [RV] lead: 32.0 °C ± 16.3 [standard deviation], right atrial [RA] lead: 16.1°C ± 9.3). In the FF orientation, LTH was significantly reduced (RV lead: 1.6°C ± 1.4; mean RA lead: 0.5°C ± 1.0; P = .008). Conclusion LTH for supine FF patient orientations among patients with anterior left-sided cardiac AIMDs can be significantly lower than LTH for supine HF orientations. There was no scenario in which LTH was significantly worse in the FF position. Changing patient orientation is a simple method to reduce radiofrequency-induced LTH.© RSNA, 2019See also the commentary by Litt in this issue.
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Affiliation(s)
- Jessica A Martinez
- Form the Departments of Radiological Sciences and Bioengineering, University of California, Los Angeles, Calif (J.A.M.); ANSYS, Canonsburg, Pa (P.S.); and Department of Radiological Sciences, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (J.A.M., D.B.E.)
| | - Peter Serano
- Form the Departments of Radiological Sciences and Bioengineering, University of California, Los Angeles, Calif (J.A.M.); ANSYS, Canonsburg, Pa (P.S.); and Department of Radiological Sciences, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (J.A.M., D.B.E.)
| | - Daniel B Ennis
- Form the Departments of Radiological Sciences and Bioengineering, University of California, Los Angeles, Calif (J.A.M.); ANSYS, Canonsburg, Pa (P.S.); and Department of Radiological Sciences, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (J.A.M., D.B.E.)
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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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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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Seewöster T, Löbe S, Hilbert S, Bollmann A, Sommer P, Lindemann F, Bacevičius J, Schöne K, Richter S, Döring M, Paetsch I, Hindricks G, Jahnke C. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: best practice and real-world experience. Europace 2019; 21:1220-1228. [DOI: 10.1093/europace/euz112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/31/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Cardiovascular magnetic resonance (CMR) imaging has long been a contraindication for patients with a cardiac implantable electronic device (CIED). Recent studies support the feasibility and safety for non-thoracic magnetic resonance imaging, but data for CMR are sparse. The aim of the current study was to determine the safety in patients with magnetic resonance (MR)-conditional or non-MR-conditional CIED and to develop a best practice approach.
Methods and results
All patients with a CIED undergoing CMR imaging (1.5 T) between April 2014 and April 2017 were included in the study. Devices were programmed according to the standardized protocol directly before and after the CMR examination. Follow-up interrogation was performed 6 months after CMR examination. Results were compared with a large, reference cohort of CIED patients not undergoing any MR examination. A total of 200 consecutive patients with a CIED (non-MR-conditional, n = 103) were included in the study. Directly after CMR imaging, one device failure (0.5%, battery status = end of service) was noted necessitating premature generator replacement. In three patients (2%) of pacemaker/implantable cardioverter-defibrillator (ICD) carriers a sustained ventricular tachycardia (VT) occurred during CMR imaging. Ten ICD showed a decrease in battery capacity immediately after CMR. Overall, the reference cohort showed comparable changes of CIED function during follow-up.
Conclusion
With adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Susanne Löbe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69A, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstraße 11, Bad Oeynhausen, Germany
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Justinas Bacevičius
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Katharina Schöne
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Michael Döring
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69A, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpelstr. 39, Leipzig, Germany
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Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices. Int J Cardiol 2019; 279:72-78. [PMID: 30642645 DOI: 10.1016/j.ijcard.2019.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/17/2018] [Accepted: 01/02/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. METHODS 136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. RESULTS CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. CONCLUSION The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.
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Han D, Kang SH, Cho Y, Oh IY. Experiences of magnetic resonance imaging scanning in patients with pacemakers or implantable cardioverter-defibrillators. Korean J Intern Med 2019; 34:99-107. [PMID: 29609452 PMCID: PMC6325447 DOI: 10.3904/kjim.2017.251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS Despite the U.S. Food and Drug Adminstration approving a magnetic resonance imaging (MRI)-conditional pacemaker system in 2011, many physicians remain reluctant to perform MRI scanning in patients with cardiac implantable electronic devices. Herein, we aimed to evaluate the real-world safety of MRI in these patients. METHODS This single-center retrospective study examined the interrogation data and outcomes of patients with pacemakers or implantable cardioverter defibrillators who underwent MRI. MRI interrogation data were collected pre- and post-MRI and after 1 month of follow-up; these included the lead impedance, measured P- and R-wave amplitudes, and capture threshold. We compared these results between the magnetic resonance (MR)-conditional and conventional groups. RESULTS From September 2013 to December 2015, 35 patients with cardiac implantable electronic devices underwent 43 MRI scans, with a mean follow-up of 5 months. Among these 35 patients, 14 (40%) had MR-conditional devices and 21 (60%) had conventional devices. Seven patients had high voltage devices, which were all the conventional type. There were no adverse events associated with MRI during the follow-up period, and there were no significant differences in the interrogation data changes between the conventional and MR-conditional groups. CONCLUSION This single-center retrospective study found that MRI can be performed safely in patients with pacemakers or implantable cardioverter defibrillators, regardless of the MRI support, as long as appropriate precautions are taken.
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Affiliation(s)
- Donghoon Han
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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50
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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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