Effect of 1.5 tesla nuclear magnetic resonance imaging scanner on implanted permanent pacemakers

Hayes, David L.; Holmes, David R.; Gray, Joel E.

doi:10.1016/s0735-1097(87)80270-x

Cited by 129 publications

(74 citation statements)

References 4 publications

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“…18 Strong electromagnetic fields may also cause asynchronous pacing, activate tachyarrhythmia therapies, or inhibit a demand pacemaker. 19 Despite these concerns, previous case series have reported the safety of MRI in the setting of pacemakers.…”

Section: Editorial P 1232 Clinical Perspective P 1284mentioning

confidence: 99%

Clinical Utility and Safety of a Protocol for Noncardiac and Cardiac Magnetic Resonance Imaging of Patients With Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla

et al. 2006

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Background-Magnetic resonance imaging (MRI) is an important diagnostic modality currently unavailable for millions of patients because of the presence of implantable cardiac devices. We sought to evaluate the diagnostic utility and safety of noncardiac and cardiac MRI at 1.5T using a protocol that incorporates device selection and programming and limits the estimated specific absorption rate of MRI sequences. Methods and Results-Patients with no imaging alternative and with devices shown to be MRI safe by in vitro phantom and in vivo animal testing were enrolled. Of 55 patients who underwent 68 MRI studies, 31 had a pacemaker, and 24 had an implantable defibrillator. Pacing mode was changed to "asynchronous" for pacemaker-dependent patients and to "demand" for others. Magnet response and tachyarrhythmia functions were disabled. Blood pressure, ECG, oximetry, and symptoms were monitored. Efforts were made to limit the system-estimated whole-body average specific absorption rate to 2.0 W/kg (successful in Ͼ99% of sequences) while maintaining the diagnostic capability of MRI. No episodes of inappropriate inhibition or activation of pacing were observed. There were no significant differences between baseline and immediate or long-term (median 99 days after MRI) sensing amplitudes, lead impedances, or pacing thresholds. Diagnostic questions were answered in 100% of nonthoracic and 93% of thoracic studies. Clinical findings included diagnosis of vascular abnormalities (9 patients), diagnosis or staging of malignancy (9 patients), and assessment of cardiac viability (13 patients). Conclusions-Given appropriate precautions, noncardiac and cardiac MRI can potentially be safely performed in patients with selected implantable pacemaker and defibrillator systems.

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Section: Editorial P 1232 Clinical Perspective P 1284mentioning

confidence: 99%

Clinical Utility and Safety of a Protocol for Noncardiac and Cardiac Magnetic Resonance Imaging of Patients With Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla

et al. 2006

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“…Cardiac pacemakers present potential problems to patients undergoing MR procedures from several mechanisms, including: 1) movement of the pacemaker (implantable pulse generator and/or leads) due to the strong static magnetic field of the MR system; 2) MRIrelated heating of the pacemaker lead by the time-varying fields; 3) inhibition or modification of the function of the pacemaker by the electromagnetic fields used for MRI; and 4) inappropriate or rapid pacing due to pulsed gradient magnetic fields and/or pulsed radio frequency (RF) fields (i.e., electromagnetic interference) from the operating MR system (i.e., with the pacing lead acting as an antenna) (4,5,8,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60). These problems may result in serious injuries or lethal consequences for patients.…”

Section: Mr Safe Fiber-optic Cardiac Pacing Leadmentioning

confidence: 99%

Magnetic resonance safety update 2002: Implants and devices

Shellock

2002

Magnetic Resonance Imaging

250

279

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The preservation of a safe magnetic resonance (MR) environment requires constant vigilance by MR healthcare professionals, particularly with regard to the management of patients with metallic biomedical implants or devices. The variety and complexity of implants and devices constantly changes, requiring continuous attention and diligence with regard to obtaining the most current and accurate information about these objects relative to the MR environment. This review article discusses MR safety and MR compatibility issues and presents important information for a variety of implants and devices, with an emphasis on those objects that have recently undergone evaluation or that require additional consideration because of existing controversy or confusion.

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“…The potential effects of MRI on PMs, ICDs, and other active implantable medical devices (AIMDs) include: force and torque effects (7,8); an undefined reedswitch state within the static magnetic field (9); the potential risk of heart stimulation and inappropriate pacing (10,11); and heating effects at the lead tip (12)(13)(14).…”

mentioning

confidence: 99%

In vitro investigation of pacemaker lead heating induced by magnetic resonance imaging: Role of implant geometry

Calcagnini¹,

Triventi²,

Censi³

et al. 2008

Magnetic Resonance Imaging

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Purpose:To evaluate the effect of the geometry of implantable pacemakers (PMs) on lead heating induced by magnetic resonance imaging (MRI). Materials and Methods:In vitro experiments were conducted with two different setups, using fluoroptic probes to measure the temperature increase. The first experiment consisted of a rectangular box filled with a gelled saline and a pacemaker with its leads. This box was exposed in an MRI birdcage coil to a sinusoidal 64-MHz field with a calibrated whole-body specific absorption rate (WB-SAR) of 1 W/kg. The highest SAR and temperature increase (3000 W/kg, 12°C) occurred for the implant configuration having the largest area. The second experimental setup consisted of a human-shaped torso filled with gelled saline. In this setup the PM and its lead were exposed to a real MRI scanner, using clinical sequences with WB-SAR up to 2 W/kg. Results:We found that higher heating occurs for configurations with longer exposed lead lengths and that right chest PMs showed the highest temperature and local SAR (11.9°C, 2345 W/kg), whereas the left chest PMs were less heated (6.3°C, 1362 W/kg). Implant geometry, exposed lead length, and lead area must be considered in the wide variation of temperature increases induced by MRI. Conclusions:The amount of MRI-induced lead tip heating depends strongly on implant geometry, particularly the lead area, exposed lead length, and position of the implant in the phantom. Critical lead tip heating was found for the longer leads. Therefore, to minimize MRI-induced lead tip heating, the PM lead should be as short as possible.

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Effect of 1.5 tesla nuclear magnetic resonance imaging scanner on implanted permanent pacemakers

Cited by 129 publications

References 4 publications

Clinical Utility and Safety of a Protocol for Noncardiac and Cardiac Magnetic Resonance Imaging of Patients With Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla

Clinical Utility and Safety of a Protocol for Noncardiac and Cardiac Magnetic Resonance Imaging of Patients With Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla

Magnetic resonance safety update 2002: Implants and devices

In vitro investigation of pacemaker lead heating induced by magnetic resonance imaging: Role of implant geometry

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