Clinical InvestigationImaging and Diagnostic TestingSafety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T
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.
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Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document
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2022, Magnetic Resonance ImagingCitation 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 CirculationCitation 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].
Where do we go from here? Beyond the MagnaSafe trial: A focus beyond a ‘safety-first’ notion. An MRI study in 500 consecutive patients
2021, International Journal of Cardiology