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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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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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3
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Gonska BD. [Magnetic resonance imaging in cardiological patients : Basic principles for application]. Herzschrittmacherther Elektrophysiol 2022; 33:268-271. [PMID: 35781835 DOI: 10.1007/s00399-022-00877-5] [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: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Magnetic resonance imaging (MRI) can be safely performed in patients with cardiac implants such as pacemakers and cardioverter defibrillators (ICD). Prerequisites for safe use are knowledge of the physical conditions as well as professional indication and cardiological monitoring by an experienced cardiologist.
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Huang X, Jiang GJ. Magnetic resonance imaging interactions with a sacral neuromodulation system. Neurourol Urodyn 2021; 40:1862-1868. [PMID: 34487571 PMCID: PMC9290516 DOI: 10.1002/nau.24756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Aims Sacral neuromodulation (SNM) has successfully treated patients with functional urinary and/or bowel disorders for more than two decades. Historically, patients with the InterStim system (Medtronic) were contraindicated for Magnetic Resonance Imaging (MRI) scans. In 2012, Medtronic obtained Food and Drug Administration (FDA) approval for allowing 1.5 Tesla (T) MRI head scans. In September 2019, the Axonics System (Axonics) received FDA approval for 1.5 T full‐body MR Conditional labeling and then 3 T full‐body MR Conditional labeling in July 2020. In August 2020, Medtronic received 1.5 and 3 T full‐body MR Conditional labeling from the FDA for their new SNM systems (InterStim II and Micro devices with SureScanTM leads). With the advancements in MRI technology and availability of full‐body MRI eligible SNM systems, it is important for physicians to better understand MRI safety for these systems. Methods This paper explains the fundamentals of MRI physics, its interactions with active implantable medical devices (AIMDs), the subsequent potential safety hazards with emphasis on radio frequency (RF)‐related safety, and the risks associated with “Off‐label” scans, including abandoned and broken leads. Results MRI guidelines provided by the AIMD device manufacturer should be followed to ensure MRI scan safety and avoid any unnecessary risk to patients. Conclusions MRI guidelines provided by the device manufacturer are the best resource for guidance for performing safe MRI scanning. Specific conditions should be fully understood and generalizations on MRI safety claims based on partial analysis or case studies should be avoided.
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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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Lebel K, Mondesert B, Robillard J, Pham M, Terrone D, Tan S. 2020 MR Safety for Cardiac Devices: An Update for Radiologists. Can Assoc Radiol J 2020; 72:814-830. [DOI: 10.1177/0846537120967701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.
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Affiliation(s)
- Kiana Lebel
- The University of Sherbrooke, Montreal, Quebec, Canada
| | | | | | - Magali Pham
- Montreal Heart Institute, Montreal, Quebec, Canada
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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: 11] [Impact Index Per Article: 2.8] [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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Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020. Anesthesiology 2020; 132:225-252. [DOI: 10.1097/aln.0000000000002821] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This practice advisory updates the “Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices,” adopted by the American Society of Anesthesiologists in 2010 and published in 2011. This updated advisory is intended for use by anesthesiologists and all other individuals who deliver or who are responsible for anesthesia care. The update may also serve as a resource for other physicians and healthcare professionals who manage patients with cardiac implantable electronic devices.
Supplemental Digital Content is available in the text.
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Özen AC, Silemek B, Lottner T, Atalar E, Bock M. MR safety watchdog for active catheters: Wireless impedance control with real-time feedback. Magn Reson Med 2020; 84:1048-1060. [PMID: 31961965 DOI: 10.1002/mrm.28153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To dynamically minimize radiofrequency (RF)-induced heating of an active catheter through an automatic change of the termination impedance. METHODS A prototype wireless module was designed that modifies the input impedance of an active catheter to keep the temperature rise during MRI below a threshold, ΔTmax . The wireless module (MR safety watchdog; MRsWD) measures the local temperature at the catheter tip using either a built-in thermistor or external data from a fiber-optical thermometer. It automatically changes the catheter input impedance until the temperature rise during MRI is minimized. If ΔTmax is exceeded, RF transmission is blocked by a feedback system. RESULTS The thermistor and fiber-optical thermometer provided consistent temperature data in a phantom experiment. During MRI, the MRsWD was able to reduce the maximum temperature rise by 25% when operated in real-time feedback mode. CONCLUSION This study demonstrates the technical feasibility of an MRsWD as an alternative or complementary approach to reduce RF-induced heating of active interventional devices. The automatic MRsWD can reduce heating using direct temperature measurements at the tip of the catheter. Given that temperature measurements are intrinsically slow, for a clinical implementation, a faster feedback parameter would be required such as the RF currents along the catheter or scattered electric fields at the tip.
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Affiliation(s)
- Ali Caglar Özen
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Consortium for Translational Cancer Research Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Berk Silemek
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.,Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Thomas Lottner
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ergin Atalar
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.,Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey
| | - Michael Bock
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Freiburg, Germany
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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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11
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Markman TM, Halperin HR, Nazarian S. Update on MRI Safety in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 288:656-657. [DOI: 10.1148/radiol.2018180360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy M. Markman
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
| | - Henry R. Halperin
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
| | - Saman Nazarian
- From the Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Founders 9118, Philadelphia, PA 19104 (T.M.M., S.N.); Division of Cardiology, Section for Cardiac Electrophysiology (H.R.H., S.N.), and Departments of Radiology and Biomedical Engineering (H.R.H.), The Johns Hopkins University, Baltimore, Md
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Nazarian S, Hansford R, Rahsepar AA, Weltin V, McVeigh D, Gucuk Ipek E, Kwan A, Berger RD, Calkins H, Lardo AC, Kraut MA, Kamel IR, Zimmerman SL, Halperin HR. Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. N Engl J Med 2017; 377:2555-2564. [PMID: 29281579 PMCID: PMC5894885 DOI: 10.1056/nejmoa1604267] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed "MRI-conditional" devices). METHODS We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter-defibrillator (42%) that was not considered to be MRI-conditional (termed a "legacy" device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters). RESULTS No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient's device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming. CONCLUSIONS We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter-defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896 .).
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Affiliation(s)
- Saman Nazarian
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Rozann Hansford
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Amir A Rahsepar
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Valeria Weltin
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Diana McVeigh
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Esra Gucuk Ipek
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Alan Kwan
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Ronald D Berger
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Hugh Calkins
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Albert C Lardo
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Michael A Kraut
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Ihab R Kamel
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Stefan L Zimmerman
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
| | - Henry R Halperin
- From the Department of Medicine-Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.); and the Departments of Medicine-Cardiology (S.N., R.H., A.A.R., V.W., D.M., E.G.I., A.K., R.D.B., H.C., A.C.L., H.R.H.), Epidemiology (S.N.), Radiology (A.C.L., M.A.K., I.R.K., S.L.Z., H.R.H.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins University, Baltimore
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Magnetic resonance imaging in patients with cardiac implantable electronic devices: a single-center prospective study. J Interv Card Electrophysiol 2017; 50:95-104. [DOI: 10.1007/s10840-017-0262-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Mulpuru SK, Madhavan M, McLeod CJ, Cha YM, Friedman PA. Cardiac Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series. J Am Coll Cardiol 2017; 69:189-210. [PMID: 28081829 DOI: 10.1016/j.jacc.2016.10.061] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023]
Abstract
Advances in cardiac surgery toward the mid-20th century created a need for an artificial means of stimulating the heart muscle. Initially developed as large external devices, technological advances resulted in miniaturization of electronic circuitry and eventually the development of totally implantable devices. These advances continue to date, with the recent introduction of leadless pacemakers. In this first part of a 2-part review, we describe indications, implant-related complications, basic function/programming, common pacemaker-related issues, and remote monitoring, which are relevant to the practicing cardiologist. We provide an overview of magnetic resonance imaging and perioperative management among patients with cardiac pacemakers.
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Affiliation(s)
- Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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15
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Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
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16
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Dandamudi S, Collins JD, Carr JC, Mongkolwat P, Rahsepar AA, Tomson TT, Verma N, Arora R, Chicos AB, Kim SS, Lin AC, Passman RS, Knight BP. The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices. Acad Radiol 2016; 23:1498-1505. [PMID: 27717762 DOI: 10.1016/j.acra.2016.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Studies reporting the safety of magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED) have mostly excluded examinations with the device in the magnet isocenter. The purpose of this study was to describe the safety of cardiac and thoracic spine MRI in patients with a CIED. MATERIALS AND METHODS The medical records of patients with a CIED who underwent a cardiac or thoracic spine MRI between January 2011 and December 2014 were reviewed. Devices were interrogated before and after imaging with reprogramming to asynchronous pacing in pacemaker-dependent patients. The clinical interpretability of the MRI and peak and average specific absorption rates (SARs, W/kg) achieved were determined. RESULTS Fifty-eight patients underwent 51 cardiac and 11 thoracic spine MRI exams. Twenty-nine patients had a pacemaker and 29 had an implantable cardioverter defibrillator. Seventeen percent (n = 10) were pacemaker dependent. Fifty-one patients (89%) had non-MRI-conditional devices. There were no clinically significant changes in atrial and ventricular sensing, impedance, and threshold measurements. There were no episodes of device mode changes, arrhythmias, therapies delivered, electrical reset, or battery depletion. One study was prematurely discontinued due to a patient complaint of chest pain of which the etiology was not determined. Across all examinations, the average peak SAR was 2.0 ± 0.85 W/kg with an average SAR of 0.35 ± 0.37 W/kg. Artifact significantly limiting the clinical interpretation of the study was present in 33% of cardiac MRI studies. CONCLUSIONS When a comprehensive CIED magnetic resonance safety protocol is followed, the risk of performing 1.5-T magnetic resonance studies with the device in the magnet isocenter, including in patients who are pacemaker dependent, is low.
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Hwang YM, Kim J, Lee JH, Kim M, Nam GB, Choi KJ, Kim YH. Cardiac Implantable Electronic Device Safety during Magnetic Resonance Imaging. Korean Circ J 2016; 46:804-810. [PMID: 27826339 PMCID: PMC5099336 DOI: 10.4070/kcj.2016.46.6.804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/24/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Although magnetic resonance imaging (MRI) conditional cardiac implantable electronic devices (CIEDs) have become recently available, non-MRI conditional devices and the presence of epicardial and abandoned leads remain a contraindication for MRIs. Subjects and Methods This was a single center retrospective study, evaluating the clinical outcomes and device parameter changes in patients with CIEDs who underwent an MRI from June 1992 to March 2015. Clinical and device related information was acquired by a thorough chart review. Results A total of 40 patients, 38 with a pacemaker (including epicardially located pacemaker leads) and 2 with implantable cardioverter defibrillators, underwent 50 MRI examinations. Among the patients, 11 had MRI conditional CIEDs, while the remaining had non-MRI conditional devices. Among these patients, 23 patients had traditional contraindications for an MRI: (1) nonfunctional leads (n=1, 2.5%), (2) epicardially located leads (n=9, 22.5%), (3) scanning area in proximity to a device (n=9, 22.5%), (4) devices implanted within 6 weeks (n=2, 5%), and (5) MRI field strength at 3.0 Tesla (n=6, 15%). All patients underwent a satisfactory MRI examination with no adverse events during or after the procedure. There were no significant changes in parameters or malfunctioning devices in any patients with CIEDs. Conclusion Under careful monitoring, MRI is safe to perform on patients with non-MRI conditional CIEDs, remnant leads, and epicardially located leads, as well as MRI-conditional devices.
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Affiliation(s)
- You Mi Hwang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsu Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Practice advisory on anesthetic care for magnetic resonance imaging: an updated report by the american society of anesthesiologists task force on anesthetic care for magnetic resonance imaging. Anesthesiology 2015; 122:495-520. [PMID: 25383571 DOI: 10.1097/aln.0000000000000458] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Anesthetic Care for Magnetic Resonance Imaging presents an updated report of the Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging.
Supplemental Digital Content is available in the text.
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Nordbeck P, Ertl G, Ritter O. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come? Eur Heart J 2015; 36:1505-11. [PMID: 25796053 PMCID: PMC4475571 DOI: 10.1093/eurheartj/ehv086] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers.
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Affiliation(s)
- Peter Nordbeck
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
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Rapsang AG, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations. Braz J Anesthesiol 2014; 64:205-14. [PMID: 24907883 DOI: 10.1016/j.bjane.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/28/2022] Open
Abstract
A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.
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Affiliation(s)
- Amy G Rapsang
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
| | - Prithwis Bhattacharyya
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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van der Graaf AWM, Bhagirath P, Götte MJW. MRI and cardiac implantable electronic devices; current status and required safety conditions. Neth Heart J 2014; 22:269-76. [PMID: 24733688 PMCID: PMC4031361 DOI: 10.1007/s12471-014-0544-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Magnetic resonance imaging (MRI) has evolved into an essential diagnostic modality for the evaluation of all patient categories. This gain in popularity coincided with an increase in the number of implanted cardiac implantable electronic devices (CIEDs). Therefore, questions arose with regard to the MRI compatibility of these devices. Various investigators have reported the harmless performance of MRI in patients with conventional (non-MRI conditional) devices. The recently published European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronisation therapy (CRT) indicate that MRI can be safely performed in patients with an implanted pacemaker or ICD (MRI conditional or not), as long as strict safety conditions are met. This is a major modification of the former general opinion that patients with a pacemaker or ICD were not eligible to undergo MRI. This review paper attempts to elucidate the current situation for practising cardiologists by providing a clear overview of the potential life-threatening interactions and discuss safety measures to be taken prior to and during scanning. An overview of all available MRI conditional devices and their individual restrictions is given. In addition, an up-to-date safety protocol is provided that can be used to ensure patient safety before, during and after the scan. Key points • Historically, MRI examination of patients with a CIED has been considered hazardous. • Ongoing advances in technology and increasing usage of MRI in clinical practice have led to the introduction of MRI conditional CIEDs and to more lenient regulations on the examination of patients with non-conditional CIEDs. • MRI investigations can be performed safely in selected patients when adhering to a standardised up-to-date safety protocol.
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Affiliation(s)
- A W M van der Graaf
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, the Netherlands,
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Rapsang AG, Bhattacharyya P. Marcapassos e cardioversores desfibriladores implantáveis – considerações gerais e anestésicas. Braz J Anesthesiol 2014; 64:205-14. [DOI: 10.1016/j.bjan.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022] Open
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Abstract
MRI has become an invaluable tool in the evaluation of soft tissue and bony abnormalities. The presence of a cardiac implantable electrical device (CIED) may complicate matters, however, because these devices are considered a contraindication to MRI scanning. When MRI is performed in patients with a CIED, risks include reed switch activation in older devices, lead heating, system malfunction, and significant radiofrequency noise resulting in inappropriate inhibition of demand pacing, tachycardia therapies, or programming changes. This report reviews indications and risk-benefit evaluation of MRI in patients with CIED and provides a clinical algorithm for performing MRI in patients with implanted devices.
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Cronin EM, Mahon N, Wilkoff BL. MRI in patients with cardiac implantable electronic devices. Expert Rev Med Devices 2014; 9:139-46. [DOI: 10.1586/erd.11.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Safe magnetic resonance imaging scanning of patients with cardiac rhythm devices: A role for computer modeling. Heart Rhythm 2013; 10:1815-21. [DOI: 10.1016/j.hrthm.2013.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 11/21/2022]
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Nazarian S, Beinart R, Halperin HR. Magnetic Resonance Imaging and Implantable Devices. Circ Arrhythm Electrophysiol 2013; 6:419-28. [DOI: 10.1161/circep.113.000116] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saman Nazarian
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Beinart
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Henry R. Halperin
- From the Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Schwitter J, Kanal E, Schmitt M, Anselme F, Albert T, Hayes DL, Bello D, Tóth A, Chang Y, van Osch D, Sommer T. Impact of the Advisa MRI pacing system on the diagnostic quality of cardiac MR images and contraction patterns of cardiac muscle during scans: Advisa MRI randomized clinical multicenter study results. Heart Rhythm 2013; 10:864-72. [PMID: 23434621 DOI: 10.1016/j.hrthm.2013.02.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Advisa MRI system is designed to safely undergo magnetic resonance imaging (MRI). Its influence on image quality is not well known. OBJECTIVE To evaluate cardiac magnetic resonance (CMR) image quality and to characterize myocardial contraction patterns by using the Advisa MRI system. METHODS In this international trial with 35 participating centers, an Advisa MRI system was implanted in 263 patients. Of those, 177 were randomized to the MRI group and 150 underwent MRI scans at the 9-12-week visit. Left ventricular (LV) and right ventricular (RV) cine long-axis steady-state free precession MR images were graded for quality. Signal loss along the implantable pulse generator and leads was measured. The tagging CMR data quality was assessed as the percentage of trackable tagging points on complementary spatial modulation of magnetization acquisitions (n=16) and segmental circumferential fiber shortening was quantified. RESULTS Of all cine long-axis steady-state free precession acquisitions, 95% of LV and 98% of RV acquisitions were of diagnostic quality, with 84% and 93%, respectively, being of good or excellent quality. Tagging points were trackable from systole into early diastole (360-648 ms after the R-wave) in all segments. During RV pacing, tagging demonstrated a dyssynchronous contraction pattern, which was not observed in nonpaced (n = 4) and right atrial-paced (n = 8) patients. CONCLUSIONS In the Advisa MRI study, high-quality CMR images for the assessment of cardiac anatomy and function were obtained in most patients with an implantable pacing system. In addition, this study demonstrated the feasibility of acquiring tagging data to study the LV function during pacing.
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Cronin EM, Wilkoff BL. Magnetic resonance imaging conditional pacemakers: rationale, development and future directions. Indian Pacing Electrophysiol J 2012; 12:204-12. [PMID: 23071382 PMCID: PMC3443878 DOI: 10.1016/s0972-6292(16)30543-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pacemakers and other cardiac implantable electronic devices (CIEDs) have long been considered an absolute contraindication to magnetic resonance imaging (MRI), a crucial and growing imaging modality. In the last 20 years, protocols have been developed to allow MR scanning of CIED patients with a low complication rate. However, this practice has remained limited to a relatively small number of centers, and many pacemaker patients continue to be denied access to clinically indicated imaging. The introduction of MRI conditional pacemakers has provided a widely applicable and satisfactory solution to this problem. Here, the interactions of pacemakers with the MR environment, the results of MR scanning in patients with conventional CIEDs, the development and clinical experience with MRI conditional devices, and future directions are reviewed.
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Hsu C, Parker G, Puranik R. Implantable devices and magnetic resonance imaging. Heart Lung Circ 2012; 21:358-63. [PMID: 22542861 DOI: 10.1016/j.hlc.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 11/25/2022]
Abstract
The indications for cardiovascular implantable electronic devices (CIEDs) are ever expanding, seemingly in parallel to the similar widespread increase in the use of magnetic resonance imaging (MRI), where there are clear advantages of imaging with no ionizing radiation and superior tissue contrast. However, CIEDs have traditionally been considered an absolute contraindication to MRI, posing a major limitation to investigating various pathologies after implantation of such devices. In the last decade the traditional paradigm of avoiding MRI in patients with CIEDs has been challenged with studies demonstrating relative safety at 1.5T under certain circumstances. Now with the recent approval of 'MR conditional' devices, it is becoming increasingly apparent that CIEDs should no longer be considered an absolute contraindication to MRI.
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Affiliation(s)
- Chijen Hsu
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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31
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Jung W, Zvereva V, Hajredini B, Jackle S. Safe magnetic resonance image scanning of the pacemaker patient: current technologies and future directions. Europace 2012; 14:631-7. [DOI: 10.1093/europace/eur391] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Heredia LL, Meagher TMM, Jamous MA, Hughes RJ. Long-term effect of MRI on sacral anterior root stimulator: the Stoke Mandeville experience. Spinal Cord 2011; 50:294-7. [PMID: 22105461 DOI: 10.1038/sc.2011.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Shinbane JS, Colletti PM, Shellock FG. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs. J Cardiovasc Magn Reson 2011; 13:63. [PMID: 22032338 PMCID: PMC3219582 DOI: 10.1186/1532-429x-13-63] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022] Open
Abstract
Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick M Colletti
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
| | - Frank G Shellock
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
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Hogarth AJ, Artis NJ, Sivananthan UM, Pepper CB. Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker. Heart Int 2011; 6:e19. [PMID: 22355486 PMCID: PMC3282436 DOI: 10.4081/hi.2011.e19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/19/2011] [Indexed: 01/09/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is increasingly used as the optimum modality for cardiac imaging. An aging population and rising numbers of patients with permanent pacemakers means many such individuals may require cardiac MRI scanning in the future. Whilst the presence of a permanent pacemaker is historically regarded as a contra-indication to MRI scanning, pacemaker systems have been developed to limit any associated risks. No reports have been published regarding the use of such devices with cardiac MRI in a clinical setting. We present the safe, successful cardiac MRI scan of a patient with an MRI-conditional permanent pacing system.
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Nazarian S, Hansford R, Roguin A, Goldsher D, Zviman MM, Lardo AC, Caffo BS, Frick KD, Kraut MA, Kamel IR, Calkins H, Berger RD, Bluemke DA, Halperin HR. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med 2011; 155:415-24. [PMID: 21969340 PMCID: PMC4337840 DOI: 10.7326/0003-4819-155-7-201110040-00004] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. OBJECTIVE To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. DESIGN Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896) SETTING: One center in the United States (94% of examinations) and one in Israel. PATIENTS 438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. INTERVENTION Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachyarrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist. MEASUREMENTS Activation or inhibition of pacing, symptoms, and device variables. RESULTS In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, -0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, -2 Ω [IQR, -13 to 0 Ω], -4 Ω [IQR, -16 to 0 Ω], and -11 Ω [IQR, -40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, -1.1 to 0.3 mV]), decreased RV lead impedance (median, -3 Ω, [IQR, -29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, -0.01 V, IQR, -0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming. LIMITATIONS Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed. CONCLUSION With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential.
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Affiliation(s)
- Saman Nazarian
- Johns Hopkins University, Baltimore, Maryland 21287, USA.
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Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology 2011; 114:247-61. [PMID: 21245737 DOI: 10.1097/aln.0b013e3181fbe7f6] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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MRI of patients with cardiac pacemakers: a review of the medical literature. AJR Am J Roentgenol 2011; 196:390-401. [PMID: 21257892 DOI: 10.2214/ajr.10.4239] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Numerous studies testing the use of pacemakers with MRI have been published. Our aim was to analyze these trials to determine the safety of MRI for patients with cardiac pacemakers. We performed a systematic search of peer-reviewed databases. A total of 31 articles were reviewed. CONCLUSION The data are heterogeneous with regard to MRI being considered for patients with pacemakers, and the benefits of the imaging should outweigh the risks.
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Pfeil A, Drobnik S, Rzanny R, Aboud A, Böttcher J, Schmidt P, Ortmann C, Mall G, Hekmat K, Brehm B, Reichenbach J, Mayer TE, Wolf G, Hansch A. Compatibility of temporary pacemaker myocardial pacing leads with magnetic resonance imaging: an ex vivo tissue study. Int J Cardiovasc Imaging 2011; 28:317-26. [DOI: 10.1007/s10554-011-9800-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/08/2011] [Indexed: 11/25/2022]
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Bottomley PA, Kumar A, Edelstein WA, Allen JM, Karmarkar PV. Designing passive MRI-safe implantable conducting leads with electrodes. Med Phys 2010; 37:3828-43. [PMID: 20831091 DOI: 10.1118/1.3439590] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The presence of implanted electronic devices with conducting leads and electrodes are contraindicated for magnetic resonance imaging (MRI), denying many patients its potential benefits. The prime concern is MRI's radio frequency (RF) fields, which can cause elevated local specific absorption rates (SARs) and potential heat injury. The purpose of this article is to develop and compare a range of passive implantable "MRI-safe" lead designs. METHODS Conducting leads incorporating different lengths (3-75 cm), insulation thicknesses (0-105 microm), resistances (100-3000 omega), coiled conductors (inner diameter < or = 1.2 mm), high-impedance (135-2700 omega) RF traps, and single-coiled and triple-coiled coaxial-wound "billabong" leads with reversed coil sections that oppose and reduce the induced current, are investigated both experimentally using local temperature measurements, and by numerical full-wave electromagnetic field analysis of the local SAR, in three different-sized bioanalogous model saline-gel phantoms at 1.5 T MRI and 4 W/kg exposure. RESULTS In all designs, the maximum computed 1 g average SAR and experimental temperature rise occur at the bare electrodes. Electrode heating increases with lead insulation thickness and peaks for uncoiled leads 25-50 cm long. A reasonable match between computed SAR and the point SAR estimated from thermal sensors obtained by approximating the computation volume to that of the thermal probes. Factors that maximize the impedance of leads with resistive, coiled, RF trap and billabong elements can effectively limit heating below 1-2 degrees, but folded lead configurations can be a concern. The RF trap and billabong designs can both support multiple conductors and electrodes, with billabong prototype leads also heating <1 degrees C when tested for 3 T MRI. CONCLUSIONS Lead insulation and length strongly affect implanted lead safety to RF exposure during MRI. Lead designs employing impedance and reversed winding sections offer hope for the development of passive, MRI-safe, implantable conducting leads for future human use.
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Affiliation(s)
- Paul A Bottomley
- SurgiVision, Inc., Suite B307, 1101 East 33rd Street, Baltimore, Maryland 21218, USA.
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40
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Martins RP, Baruteau AE, Treguer F, Césari O, Carsin-Nicol B, Langella B, Leclercq C, Daubert JC, Mabo P. [Magnetic resonance imaging in patients with pacemakers and implantable cardioverter-defibrillators: a systematic review]. Ann Cardiol Angeiol (Paris) 2010; 59:221-228. [PMID: 19962691 DOI: 10.1016/j.ancard.2009.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 04/19/2009] [Indexed: 05/28/2023]
Abstract
The presence of a pacemaker or an implantable cardioverter-defibrillator was historically considered a contraindication to magnetic resonance imaging (MRI), due to the risks for both patient and device: reed-switch closure responsible for asynchronous pacing, inhibition of pacing, rapid ventricular pacing, heating on the lead tip or even device displacement... However, many recent studies demonstrate that if MRI is crucial for the management of the patient, it can be performed under specific monitoring and scanning conditions and after device reprogramming. The growing implication of device constructors in constructing a MRI safety device will perhaps extend in the future the indications of this imaging modality in implanted patients.
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Affiliation(s)
- R-P Martins
- Service de cardiologie et maladies vasculaires, CHU de Rennes, 35033 Rennes cedex, France.
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 440] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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42
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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43
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EITEL CHARLOTTE, HINDRICKS GERHARD, SOMMER PHILIPP, WETZEL ULRIKE, BOLLMANN ANDREAS, GASPAR THOMAS, PIORKOWSKI CHRISTOPHER, ARYA ARASH. Safety of Remote Magnetic Navigation in Patients With Pacemakers and Implanted Cardioverter Defibrillators. J Cardiovasc Electrophysiol 2010; 21:1130-5. [DOI: 10.1111/j.1540-8167.2010.01777.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sansone M, Mirarchi L, Bracale M. Adaptive removal of gradients-induced artefacts on ECG in MRI: a performance analysis of RLS filtering. Med Biol Eng Comput 2010; 48:475-82. [PMID: 20238253 DOI: 10.1007/s11517-010-0596-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
One of the main vital signs used in patient monitoring during Magnetic Resonance Imaging (MRI) is Electro-Cardio-Gram (ECG). Unfortunately, magnetic fields gradients induce artefacts which severely affect ECG quality. Adaptive Noise Cancelling (ANC) is one of the preferred techniques for artefact removal. ANC involves the adaptive estimation of the impulse response of the system constituted by the MRI equipment, the patient and the ECG recording device. Least Mean Square (LMS) adaptive filtering has been traditionally employed because of its simplicity: anyway, it requires the choice of a step-size parameter, whose proper value for the specific application must be estimated case by case: an improper choice could yield slow convergence and unsatisfactory behaviour. Recursive Least Square (RLS) algorithm has, potentially, faster convergence while not requiring any parameter. As far as the authors' knowledge, there is no systematic analysis of performances of RLS in this scenario. In this study we evaluated the performance of RLS for adaptive removal of artefacts induced by magnetic field gradients on ECG in MRI, in terms of efficacy of suppression. Tests have been made on real signals, acquired via an expressly developed system. A comparison with LMS was made on the basis of opportune performance indices. Results indicate that RLS is superior to LMS in several respects.
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Affiliation(s)
- Mario Sansone
- Department of Biomedical, Electronic and Telecommunications Engineering, University Federico II of Naples, via Claudio 21, 80131, Naples, Italy.
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45
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Abstract
PURPOSE OF REVIEW Echocardiographic techniques have played a major role in the assessment of mechanical dyssynchrony and the selection of patients for cardiac resynchronization therapy. The accuracy and reliability of such measures, however, have recently been placed under great scrutiny. This has shifted interest to cardiovascular magnetic resonance as an alternative method to assess myocardial dyssynchrony but these methods are relatively underdeveloped and not used widely clinically. Accordingly, the purpose of this review is to highlight existing and emerging CMR acquisition methods for quantifying dyssynchrony as well as the potential role of CMR to improve patient selection for CRT. RECENT FINDINGS CMR has a number of advantages over current echocardiographic methods for the assessment of myocardial dyssynchrony including quantitative assessment of circumferential strain and myocardial scar burden and distribution. Recent studies also demonstrate the ability to perform CMR in patients with CRT devices. SUMMARY CMR assessment of myocardial dyssynchrony is a logical alternative to echocardiographic based methods that provides highly quantitative and reproducible data sets of function and scar that are predictive of CRT response. The future ability to perform CMR imaging in patients pre-CRT and post-CRT may for the first time allow full characterization of CRT response.
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46
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Nazarian S, Halperin HR. How to perform magnetic resonance imaging on patients with implantable cardiac arrhythmia devices. Heart Rhythm 2008; 6:138-43. [PMID: 19121814 DOI: 10.1016/j.hrthm.2008.10.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Saman Nazarian
- Division of Cardiology/Cardiac Arrhythmia, Johns Hopkins University, Baltimore, Maryland 21287, USA.
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47
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Calcagnini G, Triventi M, Censi F, Mattei E, Bartolini P, Kainz W, Bassen HI. In vitro investigation of pacemaker lead heating induced by magnetic resonance imaging: Role of implant geometry. J Magn Reson Imaging 2008; 28:879-86. [DOI: 10.1002/jmri.21536] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bogner P, Tóth L, Simor T, Gulyás J, Lukács G, Papp L, Repa I. Pacemaker in MR: absolute contraindication? Orv Hetil 2008; 149:435-40. [DOI: 10.1556/oh.2008.28122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Az MR-vizsgálatok elterjedésével és a pacemaker-technológia fejlődésével bizonyos pacemakerimplantált betegekben is lehetőség nyílik az MR-vizsgálat elvégzésére. A pacemakerbeteg MR-vizsgálatának hazai gyakorlata szegényes, ugyanakkor egyre több irodalmi hivatkozás található a vizsgálatok biztonságos elvégezhetőségére. Célunk volt in vitro kísérletek, vizsgálatok alapján kidolgozni a pacemakerbeteg biztonságos vizsgálatának feltételrendszerét, és bizonyítani a vizsgálat potenciális szövődményeit. Megvizsgáltuk a hazánkban gyakran alkalmazott pacemakertípusok működését és az MR-készülékkel való kölcsönhatását 0,35 és 1,5 T térerejű készülékekben. Az ICD-pacemaker in vitro kísérletek alapján a statikus és változó mágneses térrel is interakciót mutatott, ami a készülék működését jelentősen befolyásolja. Pacemakerfüggő betegeknél az MR-vizsgálatot továbbra is abszolút kontraindikációnak kell tekinteni, de nem pacemakerfüggő betegnél az MR-vizsgálat elvégezhető a megfelelő személyi és tárgyi feltételekkel. A beteg széles körű tájékoztatása után a pacemakert az MR-vizsgálat időtartamára át kell programozni, a vizsgálat befejezésével ellenőrizni és az eredeti programot visszaállítani.
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Affiliation(s)
| | - Levente Tóth
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar Szívgyógyászati Klinika Pécs
| | - Tamás Simor
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar Szívgyógyászati Klinika Pécs
| | | | - Gábor Lukács
- 1 Kaposvári Egyetem Egészségügyi Centrum Kaposvár Guba S. u. 40. 7400
| | - Lajos Papp
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar Szívgyógyászati Klinika Pécs
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Levine GN, Gomes AS, Arai AE, Bluemke DA, Flamm SD, Kanal E, Manning WJ, Martin ET, Smith JM, Wilke N, Shellock FS. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance. Circulation 2007; 116:2878-91. [PMID: 18025533 DOI: 10.1161/circulationaha.107.187256] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Advances in magnetic resonance (MR) imaging over the past 2 decades have led to MR becoming an increasingly attractive imaging modality. With the growing number of patients treated with permanent implanted or temporary cardiovascular devices, it is becoming ever more important to clarify safety issues in regard to the performance of MR examinations in patients with these devices. Extensive, although not complete, ex vivo, animal, and clinical data are available from which to generate recommendations regarding the safe performance of MR examination in patients with cardiovascular devices, as well as to ascertain caveats and contraindications regarding MR examination for such patients. Safe MR imaging involves a careful initial patient screening, accurate determination of the permanent implanted or temporary cardiovascular device and its properties, a thoughtful analysis of the risks and benefits of performing the examination at that time, and, when indicated, appropriate physician management and supervision. This scientific statement is intended to summarize and clarify issues regarding the safety of MR imaging in patients with cardiovascular devices.
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Abstract
Given the advances of MRI and cardiovascular technology, it is becoming increasingly likely that a patient with a cardiovascular device will be a candidate for an MRI procedure. However, many cardiac devices are currently considered to be contraindicated in the MR environment. This may prove to be a significant public health problem as many patients in need of MRI are denied the procedure because of the presence of a cardiovascular device. However, research studies have shown that with proper precautions and technique patients with cardiac devices can undergo successful MRI safely on the current platforms.
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Affiliation(s)
- Edward T Martin
- Cardiovascular Magnetic Resonance, Oklahoma Heart Institute, 9228 S. Mingo Road, Tulsa, OK 74133, USA.
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