Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads

Vuorinen, Aino-Maija; Paakkanen, Riitta; Karvonen, J.; Sinisalo, Juha; Holmström, Miia; Kivistö, Sari; Peltonen, Juha; Kaasalainen, Touko

doi:10.1007/s00330-021-08469-6

Cited by 15 publications

(10 citation statements)

References 35 publications

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“…Seven patients with abandoned endocardial pacing leads and one patient with an abandoned PM system were CMR scanned without adverse events. This finding is in keeping with the previous studies reporting low adverse event rates related to MRIs in patients with abandoned pacing leads [ 2 , 19 , 26 , 34 , 35 ].…”

Section: Discussionsupporting

confidence: 93%

“…There was no need for CIED revision in this case. Similar transient and persistent elevations in the pacing threshold related to MRIs in patients with CIED have been reported in previous publications [ 2 , 26 , 29 , 30 ].…”

Section: Discussionsupporting

confidence: 87%

“…Numerous large-scale studies have demonstrated the safety of thoracic MRIs in CIED patients [ 19 , 23 – 26 ]. The low adverse event rate related to CMR scanning the CIED patients (1.8%) in our study is in line with the published literature.…”

Section: Discussionmentioning

confidence: 99%

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Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

et al. 2022

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Objectives Cardiac implantable electronic device (CIED)–induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. Methods We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. Results Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). Conclusions Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. Key Points • Cardiac implantable electronic device (CIED)–induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

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Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

et al. 2022

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“…The word “significant”, however, should be interpreted with caution. A recent study on adults with abandoned or functioning epicardial leads (36) found a transient elevation of pacing threshold in one patient, and an irreversible atrial pacing lead impedance elevation (>10,000 ohms) in another. While these may have been coincidental to the timing of the MRI, the retrospective nature of the study and the timing of the impedance rise make RF heating in the MRI scanner impossible to exclude.…”

Section: Discussionmentioning

confidence: 99%

Age and lead configuration matter: A comparative study of RF-induced heating of epicardial and endocardial electronic devices in adult and pediatric anthropomorphic phantoms in 1.5 T MR

Jiang

Henry

Bhusal

et al. 2022

Preprint

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Background: Children with congenital heart defects often have life-sustaining indications for a cardiac implantable electronic device (CIED). In children, these devices are typically sewn to the heart epicardium, but the FDA has never licensed an epicardial system as MR-Conditional due to limited data. Children's hospitals default to either refusing MRI service to a vast majority of pediatric CIED patients or adopting a scan-all strategy based on results from adult studies. We argue that both approaches are flawed, and the risk-benefit decisions should be made on an individual basis. Purpose: To provide evidence-based knowledge on RF-induced heating of CIEDs in children and adults with epicardial and endocardial leads of different lengths. Study Type: Phantom Field Strength/Sequence: 1.5 T. Assessment: 120 clinically relevant epicardial and endocardial device configurations were implemented in adult and pediatric anthropomorphic phantoms. Temperature rise was recorded during RF exposure at 1.5 T. Statistical Tests: Means comparisons were implemented using two-sample t-tests, reliability analysis using interclass correlation coefficient based on a single rating, absolute-agreement, 2-way mixed-effects model. Results: There was significantly higher RF heating of epicardial leads compared to endocardial leads in the pediatric phantom (3.4 ± 3.0 °C vs. 0.6 ± 0.4 °C, p<0.001); however, there was no significant difference in the adult phantom (3.0 ± 3.2 °C vs. 2.0 ± 1.8 °C, p=0.16). Endocardial leads in the pediatric phantom generated significantly less RF heating than in the adult phantom (0.6 ± 0.4 °C vs. 2.0 ± 1.8 °C, p<0.001). Data Conclusion: Body size and lead length significantly affected RF heating. For models based on younger children with short epicardial leads (e.g., 25cm), RF heating up to 12 °C was observed, delivering a cumulative thermal dose previously associated with tissue necrosis. In contrast, RF heating in model based on children with endocardial leads was well below the heating expected from physiologic fever (3 °C).

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“…At present, the literature on occupational exposure in NMR environments is very poor [39,40] mainly when compared with the literature on the exposure characterization for healthcare staff working with magnetic resonance imaging (MRI) scanners [41,42].…”

Section: Discussionmentioning

confidence: 99%

Occupational Exposure Assessment of the Static Magnetic Field Generated by Nuclear Magnetic Resonance Spectroscopy: A Case Study

Hartwig

Sansotta

Morelli

et al. 2022

IJERPH

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Magnetic resonance (MR) systems are used in academic research laboratories and industrial research fields, besides representing one of the most important imaging modalities in clinical radiology. This technology does not use ionizing radiation, but it cannot be considered without risks. These risks are associated with the working principle of the technique, which mainly involves static magnetic fields that continuously increase—namely, the radiofrequency (RF) field and spatial magnetic field gradient. To prevent electromagnetic hazards, the EU and ICNIRP have defined workers’ exposure limits. Several studies that assess health risks for workers and patients of diagnostic MR are reported in the literature, but data on workers’ risk evaluation using nuclear MR (NMR) spectroscopy are very poor. Therefore, the aim of this research is the risk assessment of an NMR environment, paying particular attention to workers with active implantable medical devices (AIMDs). Our perspective study consisted of the measurement of the static magnetic field around a 300 MHz (7 T) NMR research spectrometer and the computation of the electric field induced by the movements of an operator. None of the calculated exposure parameters exceeded the threshold limits imposed by legislation for protection against short-term effects of acute occupational exposure, but our results revealed that the level of exposure exceeded the action level threshold limit for workers with AIMD during the execution of tasks requiring the closest proximity to the spectrometer. Moreover, the strong dependence of the induced electric field results from the walking speed models is shown. This case study represents a snapshot of the NMR risk assessment with the specific goal to increase the interest in the safety of NMR environments.

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Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads

Cited by 15 publications

References 35 publications

Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

Age and lead configuration matter: A comparative study of RF-induced heating of epicardial and endocardial electronic devices in adult and pediatric anthropomorphic phantoms in 1.5 T MR

Occupational Exposure Assessment of the Static Magnetic Field Generated by Nuclear Magnetic Resonance Spectroscopy: A Case Study

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