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Miller L, Airapetov S, Pillai A, Kalahasty G, Ellenbogen KA, Gregory Hundley W, Trankle CR. Hemodynamic response and safety of vasodilator stress cardiovascular magnetic resonance in patients with permanent pacemakers or implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2022; 33:2127-2135. [PMID: 35842792 PMCID: PMC9561044 DOI: 10.1111/jce.15630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.
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Affiliation(s)
- Lauren Miller
- School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Sergei Airapetov
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ajay Pillai
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Gautham Kalahasty
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Kenneth A. Ellenbogen
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - W. Gregory Hundley
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Cory R. Trankle
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Pavon AG, Porretta AP, Arangalage D, Domenichini G, Rutz T, Hugelshofer S, Pruvot E, Monney P, Pascale P, Schwitter J. Feasibility of adenosine stress cardiovascular magnetic resonance perfusion imaging in patients with MR-conditional transvenous permanent pacemakers and defibrillators. J Cardiovasc Magn Reson 2022; 24:9. [PMID: 35022037 PMCID: PMC8756706 DOI: 10.1186/s12968-021-00842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of stress perfusion-cardiovascular magnetic resonance (CMR) imaging remains limited in patients with implantable devices. The primary goal of the study was to assess the safety, image quality, and the diagnostic value of stress perfusion-CMR in patients with MR-conditional transvenous permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). METHODS Consecutive patients with a transvenous PPM or ICD referred for adenosine stress-CMR were enrolled in this single-center longitudinal study. The CMR protocol was performed using a 1.5 T system according to current guidelines while all devices were put in MR-mode. Quality of cine, late-gadolinium-enhancement (LGE), and stress perfusion sequences were assessed. An ischemia burden of ≥ 1.5 segments was considered significant. We assessed the safety, image quality and the occurrence of interference of the magnetic field with the implantable device. In case of ischemia, we also assessed the correlation with the presence of significant coronary lesions on coronary angiography. RESULTS Among 3743 perfusion-CMR examinations, 66 patients had implantable devices (1.7%). Image quality proved diagnostic in 98% of cases. No device damage or malfunction was reported immediately and at 1 year. Fifty patients were continuously paced during CMR. Heart rate and systolic blood pressure remained unchanged during adenosine stress, while diastolic blood pressure decreased (p = 0.007). Six patients (9%) had an ischemia-positive stress CMR and significant coronary stenoses were confirmed by coronary angiography in all cases. CONCLUSION Stress perfusion-CMR is safe, allows reliable ischemia detection, and provides good diagnostic value.
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Affiliation(s)
- Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Alessandra Pia Porretta
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dimitri Arangalage
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris, Paris, France
| | - Giulia Domenichini
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Tobias Rutz
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Sarah Hugelshofer
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Pierre Monney
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Patrizio Pascale
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
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Modenese A, Gobba F. Occupational Exposure to Electromagnetic Fields and Health Surveillance According to the European Directive 2013/35/EU. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1730. [PMID: 33579004 PMCID: PMC7916781 DOI: 10.3390/ijerph18041730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
In the European Union, health surveillance (HS) of electromagnetic fields (EMF)-exposed workers is mandatory according to the Directive 2013/35/EU, aimed at the prevention of known direct biophysical effects and indirect EMF's effects. Long-term effects are not addressed in the Directive as the evidence of a causal relationship is considered inadequate. Objectives of HS are the prevention or early detection of EMF adverse effects, but scant evidence is hitherto available on the specific procedures. A first issue is that no specific laboratory tests or medical investigations have been demonstrated as useful for exposure monitoring and/or prevention of the effects. Another problem is the existence of workers at particular risk (WPR), i.e., subjects with specific conditions inducing an increased susceptibility to the EMF-related risk (e.g., workers with active medical devices or other conditions); exposures within the occupational exposure limit values (ELVs) are usually adequately protective against EMF's effects, but lower exposures can possibly induce a health risk in WPR. Consequently, the HS of EMF-exposed workers according to the EU Directive should be aimed at the early detection and monitoring of the recognized adverse effects, as well as an early identification of WPR for the adoption of adequate preventive measures.
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Affiliation(s)
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
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