Implantable Cardioverter Defibrillator Dysfunction During and After Magnetic Resonance Imaging

Anfinsen, Ole-Gunnar; Berntsen, Rolf Franck; Aass, Halfdan; Kongsgaard, Erik; Amlie, Jan P.

doi:10.1046/j.1460-9592.2002.01400.x

Cited by 55 publications

(47 citation statements)

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“…Gimbel et al 22 reported similar findings regarding GEM-II-7273 (no damage), VENTAK-AV-1810, and MINI-IV-1790 (irreversible damage) in patients who underwent inadvertent MRI scanning when no special precautions were taken. Anfinsen et al 23 reported similar findings (ie, battery problems and false arrhythmia detection) with a Prizm-VR-1850 in a patient in whom MRI of the brain was performed without realization that an ICD had been implanted 8 days previously, with false detection of electromagnetic noise during the MRI as ventricular fibrillation.…”

Section: Icd Functionmentioning

confidence: 71%

Modern Pacemaker and Implantable Cardioverter/Defibrillator Systems Can Be Magnetic Resonance Imaging Safe

et al. 2004

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Background-MRI has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter/defibrillators (ICDs), however, is historically considered a contraindication to MRI. These devices are now smaller, with less magnetic material and improved electromagnetic interference protection. Our aim was to determine whether these modern systems can be used in an MR environment. Methods and Results-We tested in vitro and in vivo lead heating, device function, force acting on the device, and image distortion at 1.5 T. Clinical MR protocols and in vivo measurements yielded temperature changes Ͻ0.5°C. Older (manufactured before 2000) ICDs were damaged by the MR scans. Newer ICD systems and most pacemakers, however, were not. The maximal force acting on newer devices was Ͻ100 g. Modern (manufactured after 2000) ICD systems were implanted in dogs (nϭ18), and after 4 weeks, 3-to 4-hour MR scans were performed (nϭ15). No device dysfunction occurred. The images were of high quality with distortion dependent on the scan sequence and plane. Pacing threshold and intracardiac electrogram amplitude were unchanged over the 8 weeks, except in 1 animal that, after MRI, had a transient (Ͻ12 hours) capture failure. Pathological data of the scanned animals revealed very limited necrosis or fibrosis at the tip of the lead area, which was not different from controls (nϭ3) not subjected to MRI. Conclusions-These

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Section: Icd Functionmentioning

confidence: 71%

Modern Pacemaker and Implantable Cardioverter/Defibrillator Systems Can Be Magnetic Resonance Imaging Safe

et al. 2004

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“…22,30,38 Of greater concern, however, are previous reports of changes in programming and lead thresholds after MRI in patients with permanent pacemaker and ICD systems. 3,25 No programming changes were noted in the present study, likely because of our protocol's avoidance of electronic platforms susceptible to electromagnetic interference through previous in vitro and in vivo testing.…”

Section: Device and Lead Parametersmentioning

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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“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] On the basis of this early experience, position statements recommended caution in the performance of MRI in patients with an implanted cardiac device. 32,33 Subsequently, a larger prospective study examined 555 cases of scanning (including thoracic imaging) to assess the risk associated with MRI; no adverse clinical events occurred among the patients who underwent MRI, and the observed setting changes did not require device revision or reprogramming.…”

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confidence: 99%

Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator

et al. 2017

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BACKGROUNDThe presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverterdefibrillator (ICD) that was "non-MRI-conditional" (i.e., not approved by the Food and Drug Administration for MRI scanning). METHODSPatients in the registry were referred for clinically indicated nonthoracic MRI at a field strength of 1.5 tesla. Devices were interrogated before and after MRI with the use of a standardized protocol and were appropriately reprogrammed before the scanning. The primary end points were death, generator or lead failure, induced arrhythmia, loss of capture, or electrical reset during the scanning. The secondary end points were changes in device settings. RESULTSMRI was performed in 1000 cases in which patients had a pacemaker and in 500 cases in which patients had an ICD. No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI. One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI. We observed six cases of self-terminating atrial fibrillation or flutter and six cases of partial electrical reset. Changes in lead impedance, pacing threshold, battery voltage, and P-wave and R-wave amplitude exceeded prespecified thresholds in a small number of cases. Repeat MRI was not associated with an increase in adverse events. CONCLUSIONSIn this study, device or lead failure did not occur in any patient with a non-MRIconditional pacemaker or ICD who underwent clinically indicated nonthoracic MRI at 1.5 tesla, was appropriately screened, and had the device reprogrammed in accordance with the prespecified protocol. (Funded by St. Jude Medical and others; MagnaSafe ClinicalTrials.gov number, NCT00907361.)

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Implantable Cardioverter Defibrillator Dysfunction During and After Magnetic Resonance Imaging

Cited by 55 publications

References 0 publications

Modern Pacemaker and Implantable Cardioverter/Defibrillator Systems Can Be Magnetic Resonance Imaging Safe

Modern Pacemaker and Implantable Cardioverter/Defibrillator Systems Can Be Magnetic Resonance Imaging Safe

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

Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator

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