Cardiac Magnetic Resonance Imaging–Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing

Abstract

Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high‐degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.

Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

“…Our observations support these findings. In contrast, the RV pacing lead-induced artefacts have been shown to be minor and only mildly affecting the image interpretation [ 8 , 39 , 40 ]. Our study showed non-significant differences in the RV lead-induced artefact areas between subgroups of patients with different CIED types supporting that generator-related artefacts are the main factor for IQ differences.…”

Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices

“…These are systems that are implanted temporarily (generally while patients are treated for systemic infection or where recovery of intrinsic electrical conduction is expected) and consist of a generator fixed to the external chest wall with a transvenous (usually active fixation) lead attached and implanted internally. There are few reports of such devices undergoing MRI,70 71 and although clinical complications have not been reported, these should be considered for a high risk MRI, and this should only be performed when MRI is considered essential to the patient’s clinical pathway.…”

On the heart rhythm analysis using a nonlinear dynamics perspective: analytical study and electronic simulation

“…In the atrioventricular node, atrioventricular block develops [23][24][25]. In the carotid sinus, a significant fall in heart rate may be observed, also leading to a fall in blood pressure [26,27].…”