The effects of nuclear magnetic resonance on patients with cardiac pacemakers.

Pavlicek, William; Geisinger, Michael A.; Castle, Lon W.; Borkowski, Gregory P.; Meaney, T F; Bream, Bruce L.; Gallagher, Joe H.

doi:10.1148/radiology.147.1.6828720

Cited by 189 publications

(27 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The medical literature from the pre-MR conditional cardiac device era arises from: 1) in vitro investigations of cardiac pacemakers and implantable cardiac defibrillators (ICDs), 2) isolated case reports, 3) retrospective series of patients with devices unintentionally or intentionally placed in the MRI environment and 4) prospective studies with defined patient and MR conditions [4-69]. Additionally, a physician initiated prospective multicenter site registry of pacemakers and ICDs using 1.5 Tesla non-thoracic scans has been initiated (The MagnaSafe Registry) [70,71].…”

Section: Introductionmentioning

confidence: 99%

“…The transfer of electromagnetic energy can lead to myocardial electrical stimulation, tissue destruction at the lead tip/endocardial interface, pain, and damage to the pulse generator circuitry/battery. This may produce adverse effects on sensing, pacing thresholds, and lead impedances, and can cause inappropriate pacing acceleration or inhibition, and battery depletion [4,6,7,9,20,29,31,33,36,41,43,50,52,61,62,98-100] In a recent investigation by Wilkoff et al [81] on an MR conditional pacing system, these adverse effects were not observed. Pacing thresholds did not change significantly between patients with the device who were scanned and those who served as control patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

Shinbane

Colletti

Shellock

2011

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

Shinbane

Colletti

Shellock

2011

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

show abstract

“…Pavlicek et al [8] were the first (1983) to discuss the potential interaction between pacing devices and the NMR (at that time nuclear magnetic resonance) environment using ex-vivo pacemakers of deceased patients. These interactions can be subdivided into three categories.…”

Section: Interaction Between the Mri System And Ciedsmentioning

confidence: 99%

MRI and cardiac implantable electronic devices; current status and required safety conditions

2014

View full text Add to dashboard Cite

Magnetic resonance imaging (MRI) has evolved into an essential diagnostic modality for the evaluation of all patient categories. This gain in popularity coincided with an increase in the number of implanted cardiac implantable electronic devices (CIEDs). Therefore, questions arose with regard to the MRI compatibility of these devices. Various investigators have reported the harmless performance of MRI in patients with conventional (non-MRI conditional) devices. The recently published European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronisation therapy (CRT) indicate that MRI can be safely performed in patients with an implanted pacemaker or ICD (MRI conditional or not), as long as strict safety conditions are met. This is a major modification of the former general opinion that patients with a pacemaker or ICD were not eligible to undergo MRI. This review paper attempts to elucidate the current situation for practising cardiologists by providing a clear overview of the potential life-threatening interactions and discuss safety measures to be taken prior to and during scanning. An overview of all available MRI conditional devices and their individual restrictions is given. In addition, an up-to-date safety protocol is provided that can be used to ensure patient safety before, during and after the scan.Key points• Historically, MRI examination of patients with a CIED has been considered hazardous.• Ongoing advances in technology and increasing usage of MRI in clinical practice have led to the introduction of MRI conditional CIEDs and to more lenient regulations on the examination of patients with non-conditional CIEDs.• MRI investigations can be performed safely in selected patients when adhering to a standardised up-to-date safety protocol.

show abstract

“…Phantom studies have demonstrated the potential for pacemakers to move when placed within the static magnetic field of an MRI unit. 17 In reality, the magnetic force and torque generated by the static magnetic field of a 1.5 T scanner does not pose a safety concern for modern pacemakers that are smaller, contain fewer moving parts and little ferromagnetic material. Pacing leads are nowadays constructed from materials that are less magnetically susceptible (MP35N or drawn brazen strand) and as such pose little risk of movement or dislodgement.…”

Section: Reed Switch Activation and Pacemaker Displacementmentioning

confidence: 99%

Not All Pacemakers Are Created Equal: MRI Conditional Pacemaker and Lead Technology

Ahmed

Morris

Allen

et al. 2013

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Due to expanding clinical indications and an aging society there has been an increase in the use of implantable pacemakers. At the same time, due to increased diagnostic yield over other imaging modalities and the absence of ionizing radiation, there has been a surge in demand for magnetic resonance imaging (MRI) assessment, of both cardiac and noncardiac conditions. Patients with an implantable device have a 50-75% chance of having a clinical indication for MRI during the lifetime of their device. The presence of an implantable cardiac device has been seen as a relative contraindication to MRI assessment, limiting the prognostic and diagnostic utility of MRI in many patients with these devices. The introduction of MRI conditional pacemakers will enable more patients to undergo routine MRI assessment without risk of morbidity or device malfunction. This review gives a general overview of the principles and current evidence for the use of MRI conditional implantable cardiac devices. Furthermore, we appraise the differences between those pacemakers currently released to market.

show abstract

The effects of nuclear magnetic resonance on patients with cardiac pacemakers.

Cited by 189 publications

References 0 publications

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

MRI and cardiac implantable electronic devices; current status and required safety conditions

Not All Pacemakers Are Created Equal: MRI Conditional Pacemaker and Lead Technology

Contact Info

Product

Resources

About