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Bhuva AN, Moralee R, Brunker T, Lascelles K, Cash L, Patel KP, Lowe M, Sekhri N, Alpendurada F, Pennell DJ, Schilling R, Lambiase PD, Chow A, Moon JC, Litt H, Baksi AJ, Manisty CH. Evidence to support magnetic resonance conditional labelling of all pacemaker and defibrillator leads in patients with cardiac implantable electronic devices. Eur Heart J 2021; 43:2469-2478. [PMID: 34435642 PMCID: PMC9259370 DOI: 10.1093/eurheartj/ehab350] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Many cardiac pacemakers and defibrillators are not approved by regulators for magnetic resonance imaging (MRI). Even following generator exchange to an approved magnetic resonance (MR)-conditional model, many systems remain classified 'non-MR conditional' due to the leads. This classification makes patient access to MRI challenging, but there is no evidence of increased clinical risk. We compared the effect of MRI on non-MR conditional and MR-conditional pacemaker and defibrillator leads. METHODS AND RESULTS Patients undergoing clinical 1.5T MRI with pacemakers and defibrillators in three centres over 5 years were included. Magnetic resonance imaging protocols were similar for MR-conditional and non-MR conditional systems. Devices were interrogated pre- and immediately post-scan, and at follow-up, and adverse clinical events recorded. Lead parameter changes peri-scan were stratified by MR-conditional labelling. A total of 1148 MRI examinations were performed in 970 patients (54% non-MR conditional systems, 39% defibrillators, 15% pacing-dependent) with 2268 leads. There were no lead-related adverse clinical events, and no clinically significant immediate or late lead parameter changes following MRI in either MR-conditional or non-MR conditional leads. Small reductions in atrial and right ventricular sensed amplitudes and impedances were similar between groups, with no difference in the proportion of leads with parameter changes greater than pre-defined thresholds (7.1%, 95% confidence interval: 6.1-8.3). CONCLUSIONS There was no increased risk of MRI in patients with non-MR conditional pacemaker or defibrillator leads when following recommended protocols. Standardizing MR conditions for all leads would significantly improve access to MRI by enabling patients to be scanned in non-specialist centres, with no discernible incremental risk.
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Affiliation(s)
- Anish N Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK.,Health Data Research UK, University College London, London, UK
| | - Russell Moralee
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Tamara Brunker
- Department of Radiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen Lascelles
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Lizette Cash
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Kush P Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Martin Lowe
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Neha Sekhri
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Francisco Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Richard Schilling
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Pier D Lambiase
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
| | - Anthony Chow
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
| | - Harold Litt
- Department of Radiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A John Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Charlotte H Manisty
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
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Raphael CE, Vassiliou V, Alpendurada F, Prasad SK, Pennell DJ, Mohiaddin RH. Clinical value of cardiovascular magnetic resonance in patients with MR-conditional pacemakers. Eur Heart J Cardiovasc Imaging 2015; 17:1178-85. [PMID: 26588986 DOI: 10.1093/ehjci/jev305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 02/07/2023] Open
Abstract
AIMS Magnetic resonance (MR) conditional pacemakers are increasingly implanted into patients who may need cardiovascular MR (CMR) subsequent to device implantation. We assessed the added value of CMR for diagnosis and management in this population. METHODS AND RESULTS CMR and pacing data from consecutive patients with MR conditional pacemakers were retrospectively reviewed. Images were acquired at 1.5 T (Siemens Magnetom Avanto). The indication for CMR and any resulting change in management was recorded. The quality of CMR was rated by an observer blinded to clinical details, and data on pacemaker and lead parameters were collected pre- and post-CMR. Seventy-two CMR scans on 69 patients performed between 2011 and 2015 were assessed. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Steady-state free precession (SSFP) cine imaging resulted in a greater frequency of non-diagnostic imaging (22 vs. 1%, P < 0.01) compared with gradient echo sequences (GRE). Right-sided pacemakers were associated with less artefact than left-sided pacemakers. Late gadolinium enhancement imaging was performed in 59 scans with only 2% of segments rated of non-diagnostic quality. The CMR data resulted in a new diagnosis in 27 (38%) of examinations; clinical management was changed in a further 18 (25%). CONCLUSIONS CMR in patients with MR conditional pacemakers provided diagnostic or management-changing information in the majority (63%) of our cohort. The use of gradient echo cine sequences can reduce rates of non-diagnostic imaging. Right-sided device implantation may be considered in patients likely to require CMR examination.
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Affiliation(s)
- Claire E Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Francisco Alpendurada
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Sanjay K Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Raad H Mohiaddin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
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Ferreira AM, Costa F, Tralhão A, Marques H, Cardim N, Adragão P. MRI-conditional pacemakers: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:115-24. [PMID: 24851058 PMCID: PMC4019608 DOI: 10.2147/mder.s44063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Use of both magnetic resonance imaging (MRI) and pacing devices has undergone remarkable growth in recent years, and it is estimated that the majority of patients with pacemakers will need an MRI during their lifetime. These investigations will generally be denied due to the potentially dangerous interactions between cardiac devices and the magnetic fields and radio frequency energy used in MRI. Despite the increasing reports of uneventful scanning in selected patients with conventional pacemakers under close surveillance, MRI is still contraindicated in those circumstances and cannot be considered a routine procedure. These limitations prompted a series of modifications in generator and lead engineering, designed to minimize interactions that could compromise device function and patient safety. The resulting MRI-conditional pacemakers were first introduced in 2008 and the clinical experience gathered so far supports their safety in the MRI environment if certain conditions are fulfilled. With this technology, new questions and controversies arise regarding patient selection, clinical impact, and cost-effectiveness. In this review, we discuss the potential risks of MRI in patients with electronic cardiac devices and present updated information regarding the features of MRI-conditional pacemakers and the clinical experience with currently available models. Finally, we provide some guidance on how to scan patients who have these devices and discuss future directions in the field.
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Affiliation(s)
- António M Ferreira
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Francisco Costa
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - António Tralhão
- Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
| | - Hugo Marques
- Radiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Pedro Adragão
- Cardiology Department, Hospital da Luz, Lisbon, Portugal ; Cardiology Department, Hospital Santa Cruz-CHLO, Lisbon, Portugal
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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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