Elsevier

American Heart Journal

Volume 161, Issue 6, June 2011, Pages 1096-1105
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T

https://doi.org/10.1016/j.ahj.2011.03.007Get rights and content

Background

Recent studies suggest that magnetic resonance (MR) imaging of the brain and spine may safely be performed in patients with pacemakers (PMs) and implantable cardioverter/defibrillators (ICDs), when taking adequate precautions. The aim of this study was to investigate safety, feasibility, and diagnostic value (DV) of MR imaging in cardiac applications (cardiac MR [CMR]) in patients with PMs and ICDs for the first time.

Methods

Thirty-two PM/ICD patients with a clinical need for CMR were examined. The specific absorption rate was limited to 1.5 W/kg. Devices were reprogrammed pre-CMR to minimize interference with the electromagnetic fields. Devices were interrogated pre-CMR and post-CMR and after 3 months. Troponin I levels were measured pre-CMR and post-CMR; image quality (IQ) and DV of CMR were assessed.

Results

All devices could be reprogrammed normally post-CMR. No significant changes of pacing capture threshold, lead impedance, and troponin I were observed. Image quality in patients with right-sided devices (RSD) was better compared with that in patients with left-sided devices (LSD) (P < .05), and less myocardial segments were affected by device-related artefacts (P < .05). Diagnostic value was rated as sufficiently high, allowing for diagnosis, or better in 12 (100%) of 12 patients with RSD, and only in 7 (35%) of 20 patients with LSD.

Conclusions

Cardiac MR may be performed safely when limiting specific absorption rate, appropriately monitoring patients, and following device reprogramming. Cardiac MR delivers good IQ and DV in patients with RSD. Cardiac MR in patients with RSD may therefore be performed with an acceptable risk/benefit ratio, whereas the risk/benefit ratio is rather unfavorable in patients with LSD.

Section snippets

Background

Recent studies have demonstrated that magnetic resonance (MR) imaging in patients with cardiac pacemakers (PMs) and implantable cardioverters/defibrillators (ICDs) may be performed safely when both MR imaging–related and ICD/PM-related safety strategies are applied. This has led to a paradigm shift from PMs and ICDs being an absolute contraindication to a relative contraindication only.1, 2, 3, 4, 5, 6, 7 Most of these studies excluded the thoracic region or the heart, and currently, only 1

Study population

Pacemaker and ICD patients with a clinical indication for CMR were enrolled in this study. The institutional review board approved the study protocol. Informed consent was obtained from all subjects. Cardiac MR was only performed in PM/ICD systems that had been implanted for a minimum time of 3 months and had stable physical parameters (battery-estimated remaining lifetime, >6 months; pacing lead impedances, 200-2000 Ω; shock lead impedance, 10-80 Ω) and stable functional parameters (pacing

Study population

The study population consisted of 32 consecutive patients (mean age, 60.2 years; range, 23.1-75.7 years; 22 PMs, 10 ICDs). The ICD/PM system characteristics are given in Table I. Follow-up device interrogation could be performed in 31 of 32 MR imaging examinations; 1 patient died during the follow-up period because of septic multiorgan failure after cardiac surgery.

Discussion

To the authors' knowledge, this is the first study systematically evaluating procedure safety, IQ, and diagnostic value of CMR in patients with PM or ICD devices. The most important findings are that first, CMR may be performed safely in carefully selected patients when using safety precautions such as limiting RF power and performing close patient monitoring and appropriate device reprogramming; and second, susceptibility artefacts caused by the implanted PM/ICD systems severely limit the

Disclosures

Conflicts of Interest: J.O.S. is a consultant to Medtronic (Minneapolis, MN) and St Jude Medical (St Paul, MN). R.L. is a consultant to Medtronic.

References (16)

  • C.P. Naehle et al.

    Magnetic resonance imaging at 1.5-T in patients with implantable cardioverter-defibrillators

    J Am Coll Cardiol

    (2009)
  • S. Achenbach et al.

    Effects of magnetic resonance imaging on cardiac pacemakers and electrodes

    Am Heart J

    (1997)
  • S. Nazarian et al.

    Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable-cardioverter defibrillators at 1.5 tesla

    Circulation

    (2006)
  • A. Roguin et al.

    Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: in vitro and in vivo assessment of safety and function at 1.5 T

    Circulation

    (2004)
  • T. Sommer et al.

    Strategy for safe performance of extrathoracic magnetic resonance imaging at 1.5 tesla in the presence of cardiac pacemakers in non–pacemaker-dependent patients. A prospective study with 115 examinations

    Circulation

    (2006)
  • T. Sommer et al.

    MR imaging and cardiac pacemakers: in-vitro evaluation and in-vivo studies in 51 patients at 0.5 T

    Radiology

    (2000)
  • C.P. Naehle et al.

    Safety of brain 3-T MR imaging with transmit-receive head coil in patients with cardiac pacemakers: pilot prospective study with 51 examinations

    Radiology

    (2008)
  • C.P. Naehle et al.

    Evaluation of cumulative effects of MR imaging on pacemaker systems at 1.5 Tesla

    Pacing Clin Electrophysiol

    (2009)
There are more references available in the full text version of this article.

Cited by (77)

  • Magnetic resonance imaging in patients with cardiac implantable electronic devices: A prospective study

    2022, Magnetic Resonance Imaging
    Citation Excerpt :

    It is therefore mandatory to replace the battery before programming an MRI in PM-dependent patients who need a scan and are close to the battery's elective replacement. Regarding the secondary objective of our study, the artifacts affected the thoracic MRIs, especially the cardiac MRIs, and the area of artifact or image distortion was greater in ICD patients than in PM patients, as described in previous studies [11,26]. In these cases, changes in image acquisition that could reduce the likelihood of artifacts should be considered [27].

  • Predictors of Cardiac Implantable Electronic Device Artifact on Cardiac MRI: The Utility of a Device Related Score

    2021, Heart Lung and Circulation
    Citation Excerpt :

    CIED artifact was seen only in patients with left-sided CIED generators in our study. In contrast with other studies [8-10], artifact was also seen with PPMs, but to a lesser degree than those with ICD/CRT-Ds (35.3% vs. 64.7%). ICD/CRT-Ds are known to cause larger artifact on CMR, proportionate with the larger size of their generator and greater amount of ferromagnetic components [8,10,11].

View all citing articles on Scopus
View full text