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Harwood M, Fahrenholtz SJ, Wellnitz CV, Kawashima A, Panda A. MRI in Adult Patients with Active and Inactive Implanted MR-conditional, MR-nonconditional, and Other Devices. Radiographics 2024; 44:e230102. [PMID: 38421911 DOI: 10.1148/rg.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Active implanted medical devices (AIMDs) enable therapy and patient monitoring by way of electrical activity and typically have a battery and electrical leads. The most common types of AIMDs include cardiac implantable electronic devices (CIEDs), spinal cord stimulators, deep brain stimulators, bone growth or fusion stimulators, other neurostimulators, and drug infusion pumps. As more patients with AIMDs undergo MRI, it is important to consider the safety of patients who have these implanted devices during MRI. The authors review the physics concepts related to MRI safety, such as peak spatial gradient magnetic field, specific absorption rate, root mean square value of the effective magnetic component of the transmitted RF pulse, and gradient slew rate, as well as the parameters necessary to remain within safety limits. The roles of MRI safety personnel, as set forth by the International Society of Magnetic Resonance in Medicine, are emphasized. In addition, the relevant information provided in vendor manuals is reviewed, with a focus on how to obtain relevant up-to-date information. The radiologist should be able to modify protocols to meet safety requirements, address possible alternatives to MRI, and weigh the potential benefits of MRI against the potential risks. A few more advanced topics, such as fractured or abandoned device leads and patients with multiple implanted medical devices, also are addressed. Recommended workflows for MRI in patients with implanted medical devices are outlined. It is important to implement an algorithmic MRI safety process, including a review of the MRI safety information; patient screening; optimal imaging; and monitoring patients before, during, and after the examination. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Shetty et al in this issue.
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Affiliation(s)
- Matthew Harwood
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Samuel J Fahrenholtz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Clinton V Wellnitz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Akira Kawashima
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Anshuman Panda
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
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Bhuva A, Charles-Edwards G, Ashmore J, Lipton A, Benbow M, Grainger D, Lobban T, Gopalan D, Slade A, Roditi G, Manisty C. Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices. Heart 2024; 110:e3. [PMID: 36104218 DOI: 10.1136/heartjnl-2022-320810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.
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Affiliation(s)
- Anish Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Geoff Charles-Edwards
- Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Representative for the British Institute of Radiology, London, UK
| | - Jonathan Ashmore
- Department of Medical Physics and Bioengineering, NHS Highland, Inverness, UK
- Representative for Institute of Physics and Engineering in Medicine, York, UK
| | | | - Matthew Benbow
- Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
- Representative for British Association of MR Radiographers, Sheffield, UK
| | - David Grainger
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Trudie Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford upon Avon, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College London, London, UK
- Representative for Royal College of Radiologists, London, UK
| | - Alistair Slade
- Cardiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Representative for British Heart Rhythm Society, Chipping Norton, UK
| | - Giles Roditi
- Radiology, Glasgow Royal Infirmary, Glasgow, UK
- Representative of the British Society of Cardiovascular Imaging and British Society of Cardiovascular CT, London, UK
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Representative of British Cardiovascular Society, London, UK
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Klotzka A, Iwańczyk S, Sobańska K, Mitkowski P, Woźniak P, Lesiak M. Abandoned Intracardiac Electrodes in an Oncological Patient. J Pers Med 2023; 13:896. [PMID: 37373885 DOI: 10.3390/jpm13060896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Cardiological and oncological patients comprise the majority of patients admitted to the emergency unit with chronic or acute conditions that are the dominant cause of death worldwide. However, electrotherapy and implantable devices (pacemakers and cardioverters) improve the prognosis of cardiological patients. We present the case report of a patient who, in the past, had a pacemaker implanted due to symptomatic sick sinus syndrome (SSS) without removing the two remaining leads. Echocardiography revealed severe tricuspid valve regurgitation. The tricuspid valve septal cusp was in a restricting position due to the two ventricular leads passing through the valve. A few years later, she was diagnosed with breast cancer. We present a 65-year-old female admitted to the department due to right ventricular failure. The patient manifested symptoms of right heart failure, predominated by ascites and lower extremity edema, despite increasing doses of diuretics. The patient underwent a mastectomy two years ago due to breast cancer and was qualified for thorax radiotherapy. A new pacemaker system was implanted in the right subclavian area as the pacemaker generator occupied the radiotherapy field. In the case of right ventricular lead removal and the need for pacing and resynchronization therapy, guidelines allow a coronary sinus for LV pacing to avoid passing the leads through the tricuspid valve. We facilitated this approach in our patient, suggesting that the percentage of ventricular pacing was very low.
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Affiliation(s)
- Aneta Klotzka
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Karolina Sobańska
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Przemysław Mitkowski
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Patrycja Woźniak
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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Bosch R. Nachsorge und MRT-Untersuchungen bei Patienten mit implantierten kardialen Aggregaten. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1738-0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungIn den 2021 publizierten ESC-Leitlinien wird im Rahmen des Kapitels über die Aggregatnachsorge insbesondere die Bedeutung der Telemetrie hervorgehoben. Durch eine telemetrische Nachsorge
sind wesentlich seltener Präsenznachsorgen notwendig bei gleichwertiger oder sogar verbesserter Sicherheit. Eine telemetrische Überwachung sollte daher bei allen Patienten mit CIED erwogen
werden.Die Leitlinien beschreiben detailliert die Möglichkeiten und Einschränkungen von MRT-Untersuchungen bei Patienten mit CIED. Programmierempfehlungen für die verschiedenen Hersteller werden
dargestellt. Unter Einhaltung entsprechender Sicherheitsstandards kann eine MRT auch ohne größeres Risiko bei Patienten mit nicht MRT-kompatiblen Systemen erfolgen.
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Affiliation(s)
- Ralph Bosch
- Cardiology, Cardio-Centrum Ludwigsburg-Bietigheim, Ludwigsburg, Deutschland
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Should they stay, or should they go: do we need to remove the old cardiac implantable electronic device if a new system is required on the contralateral side? Heart Rhythm O2 2022; 3:169-175. [PMID: 35496451 PMCID: PMC9043401 DOI: 10.1016/j.hroo.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Ipsilateral approach in patients requiring cardiac implantable electronic device (CIED) revision or upgrade may not be feasible, primarily due to vascular occlusion. If a new CIED is implanted on the contralateral side, a common practice is to explant the old CIED to avoid device interaction. Objective The purpose of this study was to assess a conservative approach of abandoning the old CIED after implanting a new contralateral device. Methods We used an artificial intelligence algorithm to analyze postimplant chest radiographs to identify those with multiple CIEDs. Outcomes of interest included device interaction, abandoned CIED elective replacement indicator (ERI) behavior, subsequent programming changes, and explant of abandoned CIED. Theoretical risk of infection with removal of abandoned CIED was estimated using a validated scoring system. Results Among 12,045 patients, we identified 40 patients with multiple CIEDs. Occluded veins were the most common indication for contralateral implantation (n = 27 [67.5%]). Fifteen abandoned CIEDs reached ERI, with 4 reverting to VVI 65. One patient underwent explant due to device interaction, and 2 required device reprogramming. Of 32 patients with an implantable cardioverter-defibrillator, 8 (25%) had treated ventricular arrhythmia. There were no failed or inappropriate therapies due to interaction. Eighteen patients (45%) had hypothetical >1% annual risk of hospitalization for device infection if the abandoned CIED had been explanted. Conclusion In patients requiring new CIED implant on the contralateral side, abandoning the old device is feasible. This approach may reduce the risk of infection and concerns regarding abandoned leads and magnetic resonance imaging scans. Knowledge of ERI behavior is essential to avoid device interactions.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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[ESC guidelines 2021 on cardiac pacing and cardiac resynchronization therapy : What's new?]. Herz 2022; 47:31-40. [PMID: 35006289 DOI: 10.1007/s00059-021-05089-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/11/2022]
Abstract
The new European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy were presented together with the new ESC heart failure guidelines at the ESC congress in September. The new document includes detailed sections on patient evaluation and clinical assessment, implantation, minimizing complications and patient follow-up. The guidelines have been updated and expanded particularly on the approach to reflex syncope, the indications after transcatheter aortic valve implantation (TAVI) and the perioperative management. The indications for cardiac resynchronization therapy (CRT) are now in line with the simultaneously published ESC heart failure guidelines. New physiological forms of stimulation and leadless pacing are now included in the guidelines.
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Vuorinen AM, Paakkanen R, Karvonen J, Sinisalo J, Holmström M, Kivistö S, Peltonen JI, Kaasalainen T. Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads. Eur Radiol 2022; 32:3830-3838. [PMID: 34989847 DOI: 10.1007/s00330-021-08469-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The European Society of Cardiology Guidelines on cardiac pacing from 2021 allow magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) but do not recommend MRI in patients with epicardial pacing leads. The clinical dilemma remains whether performing an MRI in patients with CIED and epicardial leads is safe. We aimed to evaluate the safety of performing an MRI in patients with CIED and abandoned or functioning epicardial pacing leads. METHODS We included all adult patients who underwent clinically indicated MRIs with CIED and functioning or abandoned epicardial leads in a single tertiary hospital between November 2011 and October 2019. The data were retrospectively collected. RESULTS Twenty-six MRIs were performed on 17 patients with functioning or abandoned epicardial pacing leads. Sixty-nine percent of the MRI scans (18/26) were conducted on patients with functioning epicardial pacing leads. A definite adverse event occurred in one MRI scan. This was a transient elevation of the pacing threshold in a patient with a functioning epicardial ventricular pacing lead implanted 29 years previously. An irreversible atrial pacing lead impedance elevation was detected 6 months after the MRI in another patient; the association with the previous MRI remained unclear. No adverse events were detected in MRIs performed on patients with modern (implanted in 2000 or later) functioning epicardial leads. CONCLUSIONS MRIs in patients with CIED and modern functioning epicardial pacing leads were performed without detectable adverse events. Further large-scale studies are necessary to confirm MRI safety in patients with epicardial pacing leads. KEY POINTS • Currently, MRI in patients with cardiac implantable electronic devices (CIEDs) and functioning or abandoned epicardial pacing leads is not recommended. • MRIs in patients with CIED and modern functioning epicardial leads (implanted in 2000 or later) were performed without detectable adverse events in our patient cohort. • Allowing MRI in patients with epicardial pacing leads may significantly improve the diagnostic work-up, especially in specific patient groups, such as patients with congenital heart disease.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
| | - Riitta Paakkanen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha I Peltonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Nguyen BT, Bhusal B, Rahsepar AA, Fawcett K, Lin S, Marks DS, Passman R, Nieto D, Niemzcura R, Golestanirad L. Safety of MRI in patients with retained cardiac leads. Magn Reson Med 2021; 87:2464-2480. [PMID: 34958685 PMCID: PMC8919805 DOI: 10.1002/mrm.29116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the safety of MRI in patients with fragmented retained leads (FRLs) through numerical simulation and phantom experiments. Methods Electromagnetic and thermal simulations were performed to determine the worst‐case RF heating of 10 patient‐derived FRL models during MRI at 1.5 T and 3 T and at imaging landmarks corresponding to head, chest, and abdomen. RF heating measurements were performed in phantoms implanted with reconstructed FRL models that produced highest heating in numerical simulations. The potential for unintended tissue stimulation was assessed through a conservative estimation of the electric field induced in the tissue due to gradient‐induced voltages developed along the length of FRLs. Results In simulations under conservative approach, RF exposure at B1+ ≤ 2 µT generated cumulative equivalent minutes (CEM)43 < 40 at all imaging landmarks at both 1.5 T and 3 T, indicating no thermal damage for acquisition times (TAs) < 10 min. In experiments, the maximum temperature rise when FRLs were positioned at the location of maximum electric field exposure was measured to be 2.4°C at 3 T and 2.1°C at 1.5 T. Electric fields induced in the tissue due to gradient‐induced voltages remained below the threshold for cardiac tissue stimulation in all cases. Conclusions Simulation and experimental results indicate that patients with FRLs can be scanned safely at both 1.5 T and 3 T with most clinical pulse sequences.
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Affiliation(s)
- Bach T Nguyen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bhumi Bhusal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amir Ali Rahsepar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kate Fawcett
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stella Lin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel S Marks
- Department of Electrophysiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rod Passman
- Department of Electrophysiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Donny Nieto
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard Niemzcura
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Laleh Golestanirad
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Shah MJ, Silka MJ, Silva JNA, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Bergen NHV, Wackel PL. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). JACC Clin Electrophysiol 2021; 7:1437-1472. [PMID: 34794667 DOI: 10.1016/j.jacep.2021.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California, USA.
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, New York, USA
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois, USA
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan, USA
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Melissa Olen
- Nicklaus Children's Hospital, Miami, Florida, USA
| | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, New York, USA
| | | | - Nicholas H Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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14
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2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Cardiol Young 2021; 31:1738-1769. [PMID: 34338183 DOI: 10.1017/s1047951121003413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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15
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 778] [Impact Index Per Article: 259.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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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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Wang Y, Guo R, Hu W, Zheng J, Wang Q, Jiang J, Kurpad KKN, Kaula N, Long S, Chen J, Kainz W. Magnetic resonance conditionality of abandoned leads from active implantable medical devices at 1.5 T. Magn Reson Med 2021; 87:394-408. [PMID: 34378816 DOI: 10.1002/mrm.28967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/26/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE During MR scans, abandoned leads from active implantable medical devices (AIMDs) can experience excessive heating at the lead tip, depending on the type of termination applied to the proximal contacts (proximal end treatment). The influence of different proximal end treatments (ie, [1] freely exposed in the tissue, [2] terminated with metal in contact with the tissue, or [3] capped with plastic, and thereby fully insulated, on the RF-induced lead-tip heating) are studied. A technique to ensure that MR Conditional AIMD leads remain MR Conditional even when abandoned is recommended. METHODS Abandoned leads from three MR Conditional AIMDs ([1] a sacral neuromodulation system, [2] a cardiac rhythm management pacemaker system, and [3] a deep brain stimulator system) were investigated in this study. The computational lead models (ie, the transfer functions) for different proximal end treatments were measured and used to assess the in vivo lead-tip heating for four virtual human models (FATS, Duke, Ella, and Billie) and compared with the lead-tip heating of the complete MR Conditional AIMD system. RESULT The average and maximum lead-tip heating for abandoned leads proximally capped with metal is always lower than that from the complete AIMD system. Abandoned leads proximally insulated could lead to an average in vivo temperature rise up to 3.5 times higher than that from the complete AIMD system. CONCLUSION For the three investigated AIMDs under 1.5T MR scanning, our results indicate that RF-induced lead-tip heating of abandoned leads strongly depends on the proximal lead termination. A metallic cap applied to the proximal termination of the tested leads could significantly reduce the RF-induced lead-tip heating.
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Affiliation(s)
- Yu Wang
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Ran Guo
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Wei Hu
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Jianfeng Zheng
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Qingyan Wang
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Jay Jiang
- Axonics Modulation Technologies, Irvine, California, USA
| | | | | | - Stuart Long
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Ji Chen
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
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18
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Shah MJ, Silka MJ, Silva JA, Balaji S, Beach C, Benjamin M, Berul C, Cannon B, Cecchin F, Cohen M, Dalal A, Dechert B, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril P, Karpawich P, Kim J, Krishna MR, Kubuš P, Malloy-Walton L, LaPage M, Mah D, Miyazaki A, Motonaga K, Niu M, Olen M, Paul T, Rosenthal E, Saarel E, Silvetti MS, Stephenson E, Tan R, Triedman J, Von Bergen N, Wackel P. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Heart Rhythm 2021; 18:1888-1924. [PMID: 34363988 DOI: 10.1016/j.hrthm.2021.07.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California.
| | | | | | - Cheyenne Beach
- Yale University School of Medicine, New Haven, Connecticut
| | - Monica Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York Univeristy Grossman School of Medicine, New York, New York
| | | | - Aarti Dalal
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | - Doug Mah
- Harvard Medical School, Boston, Massachussetts
| | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Reina Tan
- New York University Langone Health, New York, New York
| | - John Triedman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nicholas Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Indian Pacing Electrophysiol J 2021; 21:367-393. [PMID: 34333141 PMCID: PMC8577100 DOI: 10.1016/j.ipej.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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20
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Yao A, Goren T, Samaras T, Kuster N, Kainz W. Radiofrequency-induced heating of broken and abandoned implant leads during magnetic resonance examinations. Magn Reson Med 2021; 86:2156-2164. [PMID: 34080721 PMCID: PMC8362172 DOI: 10.1002/mrm.28836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
Purpose The risks of RF‐induced heating of active implantable medical device (AIMD) leads during MR examinations must be well understood and realistically assessed. In this study, we evaluate the potential additional risks of broken and abandoned (cut) leads. Methods First, we defined a generic AIMD with a metallic implantable pulse generator (IPG) and a 100‐cm long lead containing 1 or 2 wires. Next, we numerically estimated the deposited in vitro lead‐tip power for an intact lead, as well as with wire breaks placed at 10 cm intervals. We studied the effect of the break size (wire gap width), as well as the presence of an intact wire parallel to the broken wire, and experimentally validated the numeric results for the configurations with maximum deposited in vitro lead‐tip power. Finally, we performed a Tier 3 assessment of the deposited in vivo lead‐tip power for the intact and broken lead in 4 high resolution virtual population anatomic models for over 54,000 MR examination scenarios. Results The enhancement of the deposited lead‐tip power for the broken leads, compared to the intact lead, reached 30‐fold in isoelectric exposure, and 16‐fold in realistic clinical exposures. The presence of a nearby intact wire, or even a nearby broken wire, reduced this enhancement factor to <7‐fold over the intact lead. Conclusion Broken and abandoned leads can pose increased risk of RF‐induced lead‐tip heating to patients undergoing MR examinations. The potential enhancement of deposited in vivo lead‐tip power depends on location and type of the wire break, lead design, and clinical routing of the lead, and should be carefully considered when performing risk assessment for MR examinations and MR conditional labeling.
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Affiliation(s)
- Aiping Yao
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Tolga Goren
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niels Kuster
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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21
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Ian Paterson D, White JA, Butler CR, Connelly KA, Guerra PG, Hill MD, James MT, Kirpalani A, Lydell CP, Roifman I, Sarak B, Sterns LD, Verma A, Wan D, Crean AM, Grosse-Wortmann L, Hanneman K, Leipsic J, Manlucu J, Nguyen ET, Sandhu RK, Villemaire C, Wald RM, Windram J. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol 2021; 37:835-847. [PMID: 34154798 DOI: 10.1016/j.cjca.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
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Affiliation(s)
| | - D Ian Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - James A White
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Guerra
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Michael D Hill
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anish Kirpalani
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carmen P Lydell
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley Sarak
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Elsie T Nguyen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Villemaire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rachel M Wald
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Windram
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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22
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Gopalakrishnan PP, Gevenosky L, Biederman RWW. Feasibility of MRI in patients with non-Pacemaker/Defibrillator metallic devices and abandoned leads. ACTA ACUST UNITED AC 2021; 14:83-93. [PMID: 33777288 DOI: 10.4236/jbise.2021.143009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. Background Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. Methods We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. Results The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up. Conclusions With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
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Affiliation(s)
| | - Loretta Gevenosky
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
| | - Robert W W Biederman
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
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23
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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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Nguyen BT, Pilitsis J, Golestanirad L. The effect of simulation strategies on prediction of power deposition in the tissue around electronic implants during magnetic resonance imaging. ACTA ACUST UNITED AC 2020; 65:185007. [DOI: 10.1088/1361-6560/abac9f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dacher JN, Gandjbakhch E, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Boveda S, Jacquier A. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices. Diagn Interv Imaging 2020; 101:507-517. [PMID: 32094095 DOI: 10.1016/j.diii.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.
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Affiliation(s)
- J-N Dacher
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France.
| | - E Gandjbakhch
- Sorbonne Universités, AP-HP, Heart Institute, La Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - J Taieb
- Hospital of Aix-en-Provence, Department of Cardiology, 13100 Aix-en-Provence, France
| | - M Chauvin
- Université de Strasbourg, CHU Strasbourg, Department of Cardiology, 67000 Strasbourg, France
| | - F Anselme
- Normandie UNIV, UNIROUEN, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - A Bartoli
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
| | - L Boyer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - L Cassagnes
- Université Clermont Auvergne, CHU Clermont-Ferrand, Department of Radiology, 63000 Clermont-Ferrand, France
| | - H Cochet
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - B Dubourg
- Normandie UNIV, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, Cardiac Imaging Unit, 76000 Rouen, France
| | - L Fauchier
- Université de Tours, CHU de Tours, Department of Cardiology, 37000 Tours, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Department of Cardiology, 44200 Nantes, France
| | - D Klug
- Université de Lille, CHRU de Lille, Department of Cardiology, 59000 Lille, France
| | - G Laurent
- Université de Dijon, CHU de Dijon, Department of Cardiology, 21000 Dijon, France
| | - J Mansourati
- Université de Bretagne Occidentale, CHU de Brest, Department of Cardiology, 29200 Brest, France
| | - E Marijon
- Université de Paris, AP-HP, Department of Cardiology, Georges-Pompidou European University Hospital, 75015 Paris, France
| | - P Maury
- Université de Toulouse, Inserm U1048, Department of Cardiology, Hospital Rangueil, 31059 Toulouse, France
| | - O Piot
- Centre Cardiologique du Nord, Department of Cardiology, 93200 Saint-Denis, France
| | - F Pontana
- Université de Lille, Inserm U1011, Department of Cardiovascular Radiology, Institut Cœur-Poumon, 59000 Lille, France
| | - F Sacher
- Université de Bordeaux-Inserm, IHU LIRYC, CHU de Bordeaux, Department of Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - N Sadoul
- Université de Nancy Lorraine, CHU de Nancy, Department of Cardiology, 54511 Vandœuvre-lès-Nancy, France
| | - S Boveda
- Clinique Pasteur, Department of Cardiology, 31076 Toulouse, France
| | - A Jacquier
- Université Aix-Marseille, Centre Hospitalo-Universitaire Timone, AP-HM, Department of Radiology, CNRS, CRMBM, CEMEREM, 13005 Marseille, France
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Padmanabhan D, Kella D, Isath A, Tandon N, Mulpuru S, Deshmukh A, Kapa S, Mehta R, Dalzell C, Olson N, Felmlee J, Jondal ML, Asirvatham SJ, Watson RE, Cha YM, Friedman P. Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators. J Cardiovasc Electrophysiol 2020; 31:2931-2939. [PMID: 32757438 DOI: 10.1111/jce.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/11/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients. METHODS This is a single-center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database. The outcomes were classified as aiding in diagnosis, treatment, or both for the patients attributable to the MRI. We then assessed the incidence of adverse effects (AE) when the MRI was performed. RESULTS In 668, MRIs performed on 479 patients, only 13 (1.9%) MRIs did not aid in the diagnosis or treatment of the patient. Power-on reset events without clinical sequelae in three scans (0.45%) were the only AE. The probability of an adverse event happening without any benefit from the MRI scan was 1.1 × 10-4 . A maximum benefit in diagnosis using MRI was obtained in ruling out space-occupying lesions (121/185 scans, 65.4%). Scans performed in patients for elucidating answers to queries in treatment were most frequently done for disease staging at long term follow-up (167/470 scans, 35.5%). Conservative treatment (184/470 scans, 39%) followed by medication changes (153/470 scans, 28.7%) were the most common treatment decisions made. CONCLUSIONS The utility of MRI in patients with non-MRI-conditional CIEDs far outweighs the risk of adverse events when imaging is done in the context of a multidisciplinary program that oversees patient safety.
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Affiliation(s)
- Deepak Padmanabhan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Danesh Kella
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ameesh Isath
- Department of Medicine, Mount Sinai Morningside, New York City, New York, USA
| | - Nidhi Tandon
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramila Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Connie Dalzell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nora Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel Felmlee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary L Jondal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert E Watson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong M Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions. J Thorac Imaging 2020; 35:W1-W17. [PMID: 31855948 DOI: 10.1097/rti.0000000000000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.
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Gakenheimer‐Smith L, Etheridge SP, Niu MC, Ou Z, Presson AP, Whitaker P, Su J, Puchalski MD, Asaki SY, Pilcher T. MRI in pediatric and congenital heart disease patients with CIEDs and epicardial or abandoned leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:797-804. [DOI: 10.1111/pace.13984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Susan P. Etheridge
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Mary C. Niu
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Zhining Ou
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | - Angela P. Presson
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | | | - Jason Su
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Michael D. Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Sarah Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
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30
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Gandjbakhch E, Dacher JN, Taieb J, Chauvin M, Anselme F, Bartoli A, Boyer L, Cassagnes L, Cochet H, Defaye P, Deharo JC, Dubourg B, Fauchier L, Gras D, Klug D, Laurent G, Mansourati J, Marijon E, Maury P, Piot O, Pontana F, Sacher F, Sadoul N, Jacquier A, Boveda S. Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging on magnetic resonance imaging in patients with cardiac electronic implantable devices. Arch Cardiovasc Dis 2020; 113:473-484. [DOI: 10.1016/j.acvd.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE. Patients with cardiac implantable electronic devices (CIEDs) require cardiac MRI (CMRI) for a variety of reasons. The purpose of this study is to review and evaluate the value and safety of CMRI for patients with in situ CIEDs. CONCLUSION. Late gadolinium enhancement CMRI is the reference standard for assessing myocardial viability in patients with ventricular tachycardia before ablation of arrhythmogenic substrates. The use of late gadolinium enhancement CMRI for patients with CIEDs is safe as long as an imaging protocol is in place and precaution measures are taken.
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Balmer C, Gass M, Dave H, Duru F, Luechinger R. Magnetic resonance imaging of patients with epicardial leads: in vitro evaluation of temperature changes at the lead tip. J Interv Card Electrophysiol 2019; 56:321-326. [DOI: 10.1007/s10840-019-00627-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
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Vuorinen AM, Pakarinen S, Jaakkola I, Holmström M, Kivistö S, Kaasalainen T. Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population. Acta Radiol 2019; 60:1414-1421. [PMID: 30781967 DOI: 10.1177/0284185119830288] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Magnetic resonance imaging (MRI) in patients with cardiac pacing devices has become available despite previously being considered absolutely contraindicated. However, most institutional safety protocols have included several limitations on patient selection, leaving MRI unavailable for many patients. Purpose To evaluate the first 1000 MRI examinations conducted on patients with cardiac pacing devices at Helsinki University Hospital for any potential safety hazards and also to evaluate the long-term functionality of the safety protocol in “real-life” clinical practice. Material and Methods A total of 1000 clinically indicated MRI scans were performed with a 1.5-T MRI scanner according to the safety protocol. The following information was collected from the electronic medical record (EMR): patients’ date of birth; sex; pacing device generator model; date of MRI scan; date of the latest pacing device generator implantation; and the body region scanned. The EMR of these patients was checked and especially searched for any pacing device related safety hazards or adverse outcomes during or after the MRI scan. Results Only one potentially dangerous adverse event was noted in our study group. In addition, patients with abandoned leads, temporary pacing devices, and newly implanted pacing device generators were scanned successfully and safely. Conclusion MRI scans can be performed safely in patients with cardiac pacing devices if the dedicated safety protocol is followed.
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Affiliation(s)
- Aino-Maija Vuorinen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Pakarinen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Jaakkola
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Kivistö
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Jabehdar Maralani P, Schieda N, Hecht EM, Litt H, Hindman N, Heyn C, Davenport MS, Zaharchuk G, Hess CP, Weinreb J. MRI safety and devices: An update and expert consensus. J Magn Reson Imaging 2019; 51:657-674. [PMID: 31566852 DOI: 10.1002/jmri.26909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.
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Affiliation(s)
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University, New York, New York, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Hindman
- Department of Radiology, New York University, New York, New York, USA
| | - Chinthaka Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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Sutton R, Benditt DG. Viewpoint: Cardiac implantable electronic devices and magnetic resonance compatibility: was it really necessary? J Interv Card Electrophysiol 2019; 55:125-127. [DOI: 10.1007/s10840-019-00526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
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36
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Martinez JA, Ennis DB. MRI of Patients with Cardiac Implantable Electronic Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12. [DOI: 10.1007/s12410-019-9502-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alvarez PA, Sperry BW, Perez AL, Varian K, Raymond T, Tong M, Hussein AA, Taylor DO. Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation. Am J Transplant 2018; 18:3021-3028. [PMID: 29607624 DOI: 10.1111/ajt.14755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 01/25/2023]
Abstract
We performed a retrospective review of 402 consecutive patients who underwent heart transplantation at our institution between January 2009 and March 2017. A retained cardiovascular implantable electronic device (CIED) fragment was identified after transplantation in 49 of the 301 patients (16.2%) with CIED at baseline. Patients with retained fragments had leads with longer dwell times (median 2596 [1982, 3389] vs 1384 [610, 2202] days, P < .001), higher prevalence of previously abandoned leads (14.3% vs 2.8%, P = .003), and dual-coil defibrillator leads (98% vs 81%, P = .001) compared with patients without retained fragments. Five patients (10%) with retained CIED fragments underwent magnetic resonance imaging without adverse events. There was no difference in overall mortality between patients with and without CIED fragments (12% vs 11%, P = .81) Patients with retained fragments located in the superior vena cava had significantly higher fluoroscopic times (3.3 vs 2.9 minutes, P = .024) during subsequent endomyocardial biopsies. In a competing risk analysis, presence of a retained CIED fragment was associated with upper extremity deep venous thrombosis (sub hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.17-4.10, P = .014) but not bloodstream infection after adjusting for potential confounders. In summary, retained CIED fragments are common after heart transplantation, and are associated with longer radiation exposure during biopsy procedures and upper extremity deep venous thrombosis.
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Affiliation(s)
- Paulino A Alvarez
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brett W Sperry
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Antonio L Perez
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kenneth Varian
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy Raymond
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Tong
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman A Hussein
- Section of Cardiovascular Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - David O Taylor
- Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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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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39
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[Pacemaker and MRI in clinical practice]. Herz 2018; 43:612-616. [PMID: 30280244 DOI: 10.1007/s00059-018-4750-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The number of cardiac pacemaker wearers is continuously increasing in Germany as well as worldwide. The probability of indications for a magnetic resonance imaging (MRI) examination during the lifetime is approximately 50-75% for every person. An MRI examination is nowadays possible for pacemaker wearers under certain conditions. Due to the technical developments during the last 10 years certain MRI-conditional pacemakers are available. The recommendations of the German and American medical specialist societies currently allow an MRI examination in patients with conventional pacemakers beyond the approval conditions (off-label use) under prespecified conditions, based on the study data. This article summarizes the information on conditions of use and reprogramming strategies as well as on the study situation for the clinical routine.
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40
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Hasumi E, Fujiu K, Kojima T, Kinoshita O, Nawata K, Yamauchi H, Ono M, Komuro I. Novel extraction technique of retained pacemaker and defibrillator lead during heart transplantation. PLoS One 2018; 13:e0203172. [PMID: 30188917 PMCID: PMC6126868 DOI: 10.1371/journal.pone.0203172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/15/2018] [Indexed: 12/24/2022] Open
Abstract
Background Removal of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments. Moreover, abandoned leads and retained lead fragments are a contraindication for magnetic resonance imaging (MRI) and may be a cause of CIED infection. Objective To eliminate complications of retained lead fragments, we completely removed residual leads using an excimer laser sheath technique during OHT. We report our clinical experience and high success rate of lead extraction using the excimer laser sheath compared with manual traction during OHT. Methods and results We obtained data on 84 consecutive patients receiving OHT between August 2007 and August 2017. Thirty-nine of 84 patients had undergone CIED implantation before OHT and removal of all their leads was attempted during OHT. From 2007 to 2014, defibrillator and pacemaker leads were extracted by manual traction in all patients (N = 22). After 2015, all leads were extracted with the excimer laser sheath, and surgical assistance was prepared for the procedure (N = 17). Complete procedural success was achieved in 100% of patients in the excimer laser group and 77% of patients in the manual traction group. Conclusion Extraction of abandoned leads using the excimer laser sheath system during OHT is novel and safe technique, and has a higher success rate than extraction using manual traction during OHT.
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Affiliation(s)
- Eriko Hasumi
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail: (EH); (KF)
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail: (EH); (KF)
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kan Nawata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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41
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Lacour P, Parwani A, Huemer M, Attanasio P, Dang PL, Luebcke J, Schleussner L, Blaschke D, Boldt LH, Pieske B, Haverkamp W, Blaschke F. What physicians do in case of a failure of the pace-sense part of a defibrillation lead : Survey in Germany, Austria and Switzerland. Herz 2018; 45:362-368. [PMID: 30054714 DOI: 10.1007/s00059-018-4736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/14/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. METHODS We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. RESULTS The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. CONCLUSION Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.
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Affiliation(s)
- P Lacour
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Parwani
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Huemer
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Attanasio
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P L Dang
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Luebcke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Schleussner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L-H Boldt
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - B Pieske
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Haverkamp
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Golestanirad L, Rahsepar AA, Kirsch JE, Suwa K, Collins JC, Angelone LM, Keil B, Passman RS, Bonmassar G, Serano P, Krenz P, DeLap J, Carr JC, Wald LL. Changes in the specific absorption rate (SAR) of radiofrequency energy in patients with retained cardiac leads during MRI at 1.5T and 3T. Magn Reson Med 2018; 81:653-669. [PMID: 29893997 PMCID: PMC6258273 DOI: 10.1002/mrm.27350] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the local specific absorption rate (SAR) and heating around retained cardiac leads during MRI at 64 MHz (1.5T) and 127 MHz (3T) as a function of RF coil type and imaging landmark. METHODS Numerical models of retained cardiac leads were built from CT and X-ray images of 6 patients with retained cardiac leads. Electromagnetic simulations and bio-heat modeling were performed with MRI RF body and head coils tuned to 64 MHz and 127 MHz and positioned at 9 different imaging landmarks covering an area from the head to the lower limbs. RESULTS For all patients and at both 1.5T and 3T, local transmit head coils produced negligible temperature rise ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi> <mml:mo><</mml:mo> <mml:mn>0.1</mml:mn> <mml:mo>°</mml:mo> <mml:mi>C</mml:mi></mml:mrow> </mml:math> ) for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For body imaging with quadrature-driven coils at 1.5T, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> during a 10-min scan remained < 3°C at all imaging landmarks for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> and <6°C for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>4</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For body imaging at 3T, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> during a 10-min scan remained < 6°C at all imaging landmarks for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>2</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For shorter pulse sequences up to 2 min, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> remained < 6°C for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . CONCLUSION For the models based on 6 patients studied, simulations suggest that MRI could be performed safely using a local head coil at both 1.5T and 3T, and with a body coil at 1.5T with pulses that produced <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>4</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . MRI at 3T could be performed safely in these patients using pulses with <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>2</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> .
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Affiliation(s)
- Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.,Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Amir Ali Rahsepar
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - John E Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Kenichiro Suwa
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jeremy C Collins
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Leonardo M Angelone
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Boris Keil
- Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Peter Serano
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Jim DeLap
- ANSYS Inc., Canonsburg, Pennsylvania
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
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Nyotowidjojo IS, Skinner K, Shah AS, Bisla J, Singh S, Khoubyari R, Ott P, Kalb B, Indik JH. Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:589-596. [DOI: 10.1111/pace.13340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/05/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kristina Skinner
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Aakash S. Shah
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Jaskinwal Bisla
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Satinder Singh
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Rostam Khoubyari
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Peter Ott
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
| | - Bobby Kalb
- Department of Medical Imaging; University of Arizona College of Medicine; Tucson AZ USA
| | - Julia H. Indik
- Sarver Heart Center; University of Arizona College of Medicine; Tucson AZ USA
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Shulman RM, Hunt B. Cardiac implanted electronic devices and MRI safety in 2018-the state of play. Eur Radiol 2018; 28:4062-4065. [PMID: 29713781 DOI: 10.1007/s00330-018-5396-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
Traditionally, the presence of cardiac implanted electronic devices (CIEDs) was a contra-indication to magnetic resonance (MR) imaging. Professional groups from around the world are releasing updated guidelines for the imaging of MR-conditional and legacy CIEDs, reflecting increasing evidence that this can be performed safely when strict protocols are followed. KEY POINTS • The presence of a pacemaker or automatic implanted cardioverter defibrillator is no longer an absolute contraindication to magnetic resonance imaging. • Strict protocols enable diagnostic quality images to be obtained with minimal risk. • Close collaboration among radiologists, cardiologists and device manufacturer representatives is required.
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Affiliation(s)
- Ryan Mark Shulman
- Queensland X-Ray, Gold Coast Private Hospital, Southport, Queensland, Australia.
- Department of Medical Imaging, Gold Coast University Hospital, Southport, Queensland, Australia.
- Griffith University, Southport, Queensland, Australia.
| | - Ben Hunt
- Department of Cardiology and Electrophysiology, Pindara Private Hospital, Benowa, Queensland, Australia
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45
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Bertelsen L, Petersen HH, Philbert BT, Svendsen JH, Thomsen C, Vejlstrup N. Safety of magnetic resonance scanning without monitoring of patients with pacemakers. Europace 2018; 19:818-823. [PMID: 27738069 DOI: 10.1093/europace/euw066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The objective of this study was to investigate whether it is safe to perform 1.5-Tesla magnetic resonance imaging (MRI) scans in pacemaker (PM) patients without pulse oximetry or electrocardiogram monitoring and with no special specific absorption rate (SAR) or time limits, provided that the PMs are interrogated and programmed to asynchronous mode prior to the scan. Methods and results This study reports the outcome of 207 MRI scans on PM patients at Rigshospitalet, Copenhagen University Hospital from June 2010 to September 2013. All MRIs were performed with the PMs in asynchronous mode and without additional monitoring. There were no adverse events registered among the PM patients during the study period. The only statistically significant change after MRI scans was a small, but clinically insignificant increase in atrial sense. No occurrences of reprogramming to power-on-reset were registered. Conclusion It is possible to perform MRI scans relatively safely in PM patients without additional monitoring or change in the normal MRI protocol, given that the PM has been assessed and reprogrammed prior to MRI. This is especially important to remember in the acute setting where MRI scans may be delayed when monitoring facilities are unavailable.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Helen Høgh Petersen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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46
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Horwood L, Attili A, Luba F, Ibrahim ESH, Parmar H, Stojanovska J, Gadoth-Goodman S, Fette C, Oral H, Bogun F. Magnetic resonance imaging in patients with cardiac implanted electronic devices: focus on contraindications to magnetic resonance imaging protocols. Europace 2018; 19:812-817. [PMID: 27256419 DOI: 10.1093/europace/euw122] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/10/2016] [Indexed: 01/03/2023] Open
Abstract
Aims Magnetic resonance imaging (MRI) has been reported to be safe in patients with cardiac implantable electronic devices (CIED) provided a specific protocol is followed. The objective of this study was to assess whether this is also true for patients excluded from published protocols. Methods and results A total of 160 MRIs were obtained in 142 consecutive patients with CIEDs [106 patients had an implantable cardioverter defibrillator (ICD) and 36 had a pacemaker implanted] using an adapted, pre-specified protocol. A cardiac MRI was performed in 95 patients, and a spinal/brain MRI was performed in 47 patients. Forty-six patients (32%) had either abandoned leads (n = 10), and/or were pacemaker dependent with an implanted ICD (n = 19), had recently implanted CIEDs (n = 1), and/or had a CIED device with battery depletion (n = 2), and/or a component of the CIED was recalled or on advisory (n = 32). No major complications occurred. Some device parameters changed slightly, but significantly, right after or at 1-week post-MRI without requiring any reprogramming. In one patient with an ICD on advisory, the pacing rate changed inexplicably during one of his two MRIs from 90 to 50 b.p.m. Conclusion Using a pre-specified protocol, cardiac and non-cardiac MRIs were performed in CIED patients with pacemaker dependency, abandoned leads, or depleted batteries without occurrence of major adverse events. Patients with devices on advisory need to be monitored carefully during MRI, especially if they are pacemaker dependent.
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Affiliation(s)
- Laura Horwood
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Frank Luba
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Hemant Parmar
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sharon Gadoth-Goodman
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Carey Fette
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Hakan Oral
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI 48109-5853, USA
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Morris MF, Verma DR, Sheikh H, Su W, Pershad A. Outcomes after magnetic resonance imaging in patients with pacemakers and defibrillators and abandoned leads. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:685-688. [PMID: 29454532 DOI: 10.1016/j.carrev.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Michael F Morris
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Department of Radiology, Banner University Medical Center, Phoenix, United States.
| | - Divya Ratan Verma
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
| | - Hasaam Sheikh
- Department of Radiology, Banner University Medical Center, Phoenix, United States
| | - Wilber Su
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
| | - Ashish Pershad
- Cardiovascular Institute, Banner University Medical Center, Phoenix, United States; Division of Cardiology, Banner University Medical Center, Phoenix, United States
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Holzhauser L, Imamura T, Nayak HM, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Patel A, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation-An Underrecognized Problem. J Card Fail 2018; 24:101-108. [PMID: 29325797 PMCID: PMC5945281 DOI: 10.1016/j.cardfail.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. METHODS We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). RESULTS A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. CONCLUSION RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
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Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hemal M Nayak
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nitasha Sarswat
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sara Kalantari
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Onsager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
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Padmanabhan D, Jondal ML, Hodge DO, Mehta RA, Acker NG, Dalzell CM, Kapa S, Asirvatham SJ, Cha YM, Felmlee JP, Watson RE, Friedman PA. Mortality After Magnetic Resonance Imaging of the Brain in Patients With Cardiovascular Implantable Devices. Circ Arrhythm Electrophysiol 2018; 11:e005480. [DOI: 10.1161/circep.117.005480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Deepak Padmanabhan
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Mary L. Jondal
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - David O. Hodge
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Ramila A. Mehta
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Nancy G. Acker
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Connie M. Dalzell
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Suraj Kapa
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Yong-Mei Cha
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Joel P. Felmlee
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Robert E. Watson
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Paul A. Friedman
- From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.)
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50
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Padmanabhan D, Kella DK, Mehta R, Kapa S, Deshmukh A, Mulpuru S, Jaffe AS, Felmlee JP, Jondal ML, Dalzell CM, Asirvatham SJ, Cha YM, Watson RE, Friedman PA. Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads. Heart Rhythm 2017; 15:228-233. [PMID: 29045806 DOI: 10.1016/j.hrthm.2017.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND During magnetic resonance imaging (MRI), abandoned leads may act as antennae that result in tissue heating and arrhythmia induction. OBJECTIVE The purpose of this study was to assess the safety of MRI in patients with abandoned leads, with the addition of cardiac troponin T (cTnT) assessment to screen for myocardial damage. METHODS We reviewed our prospectively collected database of patients with cardiovascular implantable electronic devices (CIEDs) undergoing MRI between 2008 and 2017 at Mayo Clinic, Rochester, MN, and selected patients who had abandoned leads. We compared the adverse events in this population with an age, sex, and site of MRI-matched cohort of patients selected from this database. We evaluated paired (before/after) cTnT values using MRI in these patients. RESULTS Of 952 patients, 80 (8.4%) underwent 97 MRI scans with CIEDs in situ with 90 abandoned leads in place during the scans. The median age was 66 years (interquartile range 22.3 years) 66.1 years (interquartile range, Q1,Q3: 53.6, 75.9) with 66.3% (53 patients) men. There was no clinical or electrical evidence of CIED dysfunction, arrhythmias, or pain. Paired samples for the measurement of cTnT values were available in 40 patients undergoing 44 MRI examinations. The mean difference between the pre- and postimaging values was -0.002 ± 0.006 ng/mL (interquartile range 0). There was no difference after adjustment for total number of leads per patient and total number of implantable cardioverter-defibrillator coils. CONCLUSION There was no evidence of myocardial injury as measured by paired cTnT. The risk of MRI with abandoned leads appears low, suggesting a favorable risk-benefit profile in patients with CIEDs and abandoned leads who are considered for MRI.
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Affiliation(s)
| | - Danesh K Kella
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Ramila Mehta
- Division of Biomedical Statistics and Informatics, Rochester, Minnesota
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | | | - Siva Mulpuru
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Rochester, Minnesota
| | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mary L Jondal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Rochester, Minnesota
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