Strategies for the Safe Magnetic Resonance Imaging of Pacemaker‐Dependent Patients

Gimbel, John; Bailey, Shane; Tchou, Patrick; Ruggieri, Paul; Wilkoff, Bruce L.

doi:10.1111/j.1540-8159.2005.00230.x

Cited by 67 publications

(58 citation statements)

References 23 publications

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“…34 Importantly, several pacemaker-dependent patients were imaged without any evidence of device inhibition. The present study complements the findings of a previous study of head and neck MRI in pacemaker- dependent patients 26 by reporting safe musculoskeletal, brain, thoracic and abdominal MRI in pacemaker-dependent patients with generators from all 3 major manufacturers. It is vital, however, to emphasize the need for appropriate programming of the device to an asynchronous mode and the availability of pacing backup for such patients.…”

Section: Ecg Telemetrysupporting

confidence: 74%

“…25 Despite overall safety, short-term changes in battery voltage, lead thresholds, 3 and programming 25 have been noted. Importantly, the literature on MRI of pacemaker-dependent patients, 26 cardiac MRI in the setting of implantable devices, 3,27 and the diagnostic utility of MRI in device recipients 3 is limited.…”

Section: Editorial P 1232 Clinical Perspective P 1284mentioning

confidence: 99%

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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: Ecg Telemetrysupporting

confidence: 74%

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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“…[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.…”

mentioning

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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“…94 Alternatively, certain strategies to minimize complications have been suggested, including the use of less powerful MRI machines; imaging limited to extremities (ie, remote from the device); careful reprogramming of the intracardiac device, including asynchronous modes and maximal pacing output; selection of appropriate spin sequences; limitation of MRI to patients who are not pacemaker dependent; and careful, continuous periprocedure monitoring. 95 In general, however, the present use of MRI should be considered contraindicated in the patient with a pacemaker or ICD.…”

Section: Drugs Devices and Emimentioning

confidence: 99%

Contemporary Pacemaker and Defibrillator Device Therapy

Schoenfeld

2007

Circulation

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Strategies for the Safe Magnetic Resonance Imaging of Pacemaker‐Dependent Patients

Abstract: While clearly a higher risk group, like nonpacemaker-dependent patients, MRI might be performed in pacemaker-dependent patients if appropriate pacemaker reprogramming, patient monitoring, and MRI scanning techniques are implemented.

Cited by 67 publications

References 23 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

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

Contemporary Pacemaker and Defibrillator Device Therapy

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