Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices

Abstract

Magnetic resonance (MR) imaging has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter-defibrillators (ICDs), however, was historically considered a contraindication to MR imaging. We summarize the potential hazards of the device-MR environment interaction, and present updated information regarding in vitro and in vivo experiments suggesting that certain pacemaker and ICD systems may indeed be MR-safe. Recent reports on several hundred patients with implantable pacemakers and ICDs who underwent MR scan safely indicate that, under certain conditions, individuals with these implanted systems may benefit from MR imaging. We believe that, on a case-by-case basis, the diagnostic benefit from MR imaging outweighs the presumed risks for some pacemaker and ICD patients. Thus for some patients, the risks presented by MR imaging under specific, characterized scanning and monitoring conditions may be acceptable given the diagnostic benefit of this powerful imaging modality. This may have major clinical implications on current imaging practice. A strategy for the performance of MR imaging in these individuals is proposed.

MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators

“…However, various studies in the last 15 years have been able to show that it is possible to perform MR examinations with an acceptable level of risk in patients with conventional PM/ICD systems taking into consideration the individual risk/benefit profile as a single-case decision and as "off-label" use and applying specific safety precautions [1 -20]. In 2008, a European position paper regarding this topic with participation of corresponding expert groups from cardiology and radiology was published and the presence of PM/ICD systems was newly classified as a relative MR contraindication [1].…”

Decision Making Processes for a Patient with Cardiac Pacemaker Admitted to the Accident and Emergency Undergoing Magnetic Resonance Imaging – A Case Study

“…Where it contained 50% to 75% of these patients, it developed indications for MRI during their devices and showed that every year, approximately 200 000 patients with pacemakers or ICDs, MRI was rejected (Roguin et al 2008).…”

Kamrai tachycardiák katéterablatiós kezelése

“…A mágneses rezonanciás (MR-) készülékek fejlődésének köszönhetően egy jó felbontású MR-készülékkel sokkal részletesebb és pontosabb szubsztrátkeresés valósítható meg. A gond, hogy sok betegnél a már beültetésre került ICD-készülék miatt az intézetek nem végzik el a szív-MR-vizsgálatot, holott ennek biztonságossága -megfelelő programozással 1,5 T-ig -igazolt [16]. A komputertomográfi ás (CT-) vizsgálatoknak inkább a koszorúér-betegségek nem invazív diagnosztikájában van kiemelkedő szerepe, de az utóbbi években az ECHO-és MR-képalkotók mellett egyre nagyobb szerepet kap a myocardium betegségeinek diagnosztikájában [17].…”