Safety of Brain 3-T MR Imaging with Transmit-Receive Head Coil in Patients with Cardiac Pacemakers: Pilot Prospective Study with 51 Examinations

Naehle, Claas P.; Meyer, Carsten H.; Thomas, Daniel; Remerie, Susann; Krautmacher, Carsten; Litt, Harold; Luechinger, Roger; Fimmers, Rolf; Schild, Hans H.; Sommer, Torsten

doi:10.1148/radiol.2493072195

Cited by 83 publications

(65 citation statements)

References 35 publications

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“…Several relatively small studies have also reported overall safety (7, 10, 30, 33, 34). Several investigators have reported a lack of change in troponin-I levels as a surrogate of myocardial damage after MRI (11, 12, 35), and recent reports have demonstrated the overall safety of repeated MRI (36) and MRI without SAR restrictions in device recipients (26). Our study adds to the existing literature by providing substantial safety data on the largest number of patients and the most representative sampling of devices implanted to date.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of a Protocol for Magnetic Resonance Imaging of Patients With Implanted Cardiac Devices

Nazarian¹,

Hansford²,

Roguin³

et al. 2011

Ann Intern Med

281

219

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Background Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. Objective To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. Design Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896) Setting One center in the United States (94% of examinations) and one in Israel. Patients 438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. Intervention Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachy-arrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist. Measurements Activation or inhibition of pacing, symptoms, and device variables. Results In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, −0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, −2 Ω[IQR, −13 to 0 Ω], −4 Ω [IQR, −16 to 0 Ω], and −11 Ω [IQR, −40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, −1.1 to 0.3 mV]), decreased RV lead impedance (median, −3 Ω, [IQR, −29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, −0.01 V, IQR, −0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming. Limitations Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed. Conclusion With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential. Primary Funding Source National Institutes of Health.

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Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of a Protocol for Magnetic Resonance Imaging of Patients With Implanted Cardiac Devices

Nazarian¹,

Hansford²,

Roguin³

et al. 2011

Ann Intern Med

281

219

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“…There are studies demonstrating the safety of MR imaging of the brain at a field strength of 3 T using specific safety precautions [12]. However, it must be noted that doubling of the resonance frequency from appr.…”

Section: Mr-related Safety Precautions For Conventional Pacemakersmentioning

confidence: 99%

MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators

Sommer

Bauer

Fischbach

et al. 2017

Fortschr Röntgenstr

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▪ MR conditional pacemaker and ICD systems have been tested and approved for MR examination under specific conditions ("in-label" use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety. ▪ The risk for an ICD patient during MR examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems.The indication for a MR examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/ benefit ratio should be critically reviewed. ▪ This complex subject requires close collaboration between radiology and cardiology.

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“…The proximity of the generator to the end of the bore, proximity of the generator to the surface of the bore, body habitus, lead geometry and loops as well as lead system integrity [38,39] may also play a role. There may be an unpredictable change in pacemaker function such as inhibition, rapid ventricular pacing occur [30] or no change at all [40]. Furthermore there can be switching to demand mode, ventricular backup pacing activation, and electrical reset [41].…”

Section: Discussionmentioning

confidence: 99%

Immediate and 12 months follow up of function and lead integrity after cranial MRI in 356 patients with conventional cardiac pacemakers

Muehling

Wakili²,

Martin³

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundConventional cardiac pacemakers are still often regarded as a contraindication to magnetic resonance imaging (MRI). We conducted this study to support the hypothesis that it is safe to scan patients with cardiac pacemakers in a 1.5 Tesla MRI, if close supervision and monitoring as well as adequate pre- and postscan programming is provided.MethodsWe followed up 356 patients (age 61.3 ± 9.1 yrs., 229 men) with single (n = 132) or dual chamber (n = 224) cardiac pacemakers and urgent indication for a cranial MRI for 12 months. The scans were performed at 1.5T. During the scan patients were monitored with a 3-lead ECG and pulse oximetry. Prior to the scan pacemakers were programmed according to our own protocol.ResultsAll 356 scans were completed without complications. No arrhythmias were induced, programmed parameters remained unchanged. No pacemaker dysfunction was identified. Follow-up examinations were performed immediately, 2 weeks, 2, 6, and 12 months after the scan. There was no significant change of pacing capture threshold (ventricular 0.9 ± 0.4 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms) immediately (ventricular 1.0 ± 0.3 V@0.4 ms, atrial 0.9 ± 0.4 V@0.4 ms) or at 12 months follow-up examinations (ventricular 0.9 ± 0.2 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms). There was no significant change in sensing threshold (8.0 ± 4.0 mV vs. 8.1 ± 4.2 mV ventricular lead, 2.0 ± 0.9 mV vs. 2.1 ± 1.0 mV atrial lead) or lead impedance (ventricular 584 ± 179 Ω vs. 578 ± 188 Ω, atrial 534 ± 176 Ω vs. 532 ± 169 Ω) after 12 months.ConclusionsThis supports the evidence that patients with conventional pacemakers can safely undergo cranial MRI in a 1.5T system with suitable preparation, supervision and precautions. Long term follow-up did not reveal significant changes in pacing capture nor sensing threshold.

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Safety of Brain 3-T MR Imaging with Transmit-Receive Head Coil in Patients with Cardiac Pacemakers: Pilot Prospective Study with 51 Examinations

Abstract: MR imaging of the brain at 3 T in patients with a cardiac PM can be performed safely when dedicated safety precautions (including the use of a transmit-receive head coil) are taken.

Cited by 83 publications

References 35 publications

A Prospective Evaluation of a Protocol for Magnetic Resonance Imaging of Patients With Implanted Cardiac Devices

A Prospective Evaluation of a Protocol for Magnetic Resonance Imaging of Patients With Implanted Cardiac Devices

MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators

Immediate and 12 months follow up of function and lead integrity after cranial MRI in 356 patients with conventional cardiac pacemakers

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