Is magnetic resonance safe in implanted cardiac devices patients? 2012

Giulia Cernuschi, and Maurizio Cringoli, and
Universita` degli Studi di Milano, Milan, MI, Italy. giulia.cernuschi@studenti.unimi.it

Nazarian et al. [1] evaluate in a prospective non-randomized trial the safety of a 1.5 T MRI protocol for patients with implanted cardiac devices (ICD and PM). 438 participants (54 % with PM and 46 % with ICD implanted, respectively,after the 1998 and 2000) were enrolled and underwent 555MRI examinations. Patients with a recent implant(\6 weeks), those with abandoned or epicardiac leads, and PM-dependent patients with an ICD were excluded.According to the experimental protocol, an asynchronous pacing mode (VOO/DOO) was programmed in the pacemaker-dependent patients, while an inhibited pacing mode(VVI/DDI) was used for the other patients. The ICD function of non-PM-dependent patients was disabled. During the MRI examination, blood pressure, electrocardiography, pulse oximetry and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had an immediate backup from an electrophysiologist.Device variables including sensing, impedance, capture threshold and battery voltage were evaluated before MRI examination, immediately after MRI and after 3–6 months.Variations exceeding 30, 40 and 50 %for, respectively, lead impedance, sensing and capture threshold were considered as significant changes in lead performance.Baseline and immediate follow-up interrogations were performed in all 438. Long-term follow-up device variables were available for 266 patients (61 %). 3 of 438 patients(0.7 %) experienced acute power-on-reset events. None of them had device dysfunction during long-term follow-up(3–6 months). Right ventricular sensing and atrial, right and left ventricular impedances were reduced immediately after MRI. At long-term follow-up in 61 % of the patients,decreased right ventricular (RV) sensing and lead impedance,increased RV capture threshold and decreased battery voltage were noted. The observed changes did not require device revision or reprogramming. The distributions of changes in device variables were within the 20 % at baseline for most participants. Thoracic MRI sequences had a greater effect on device variables and were more likely to result in artifacts (for instance, image distortion,signal voids or bright areas and poor fat suppression).

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D004574 Electromagnetic Fields Fields representing the joint interplay of electric and magnetic forces. Electromagnetic Field,Field, Electromagnetic,Fields, Electromagnetic
D004868 Equipment Failure Failure of equipment to perform to standard. The failure may be due to defects or improper use. Defects, Equipment,Device Failure,Failure, Equipment,Malfunction, Equipment,Medical Device Failure,Misuse, Equipment,Device Failure, Medical,Device Failures, Medical,Failure, Medical Device,Failures, Medical Device,Defect, Equipment,Device Failures,Equipment Defect,Equipment Defects,Equipment Failures,Equipment Malfunction,Equipment Malfunctions,Equipment Misuse,Equipment Misuses,Failure, Device,Failures, Device,Failures, Equipment,Malfunctions, Equipment,Misuses, Equipment
D004869 Equipment Safety Freedom of equipment from actual or potential hazards. Device Safety,Hazards, Equipment,Medical Device Safety,Safety, Equipment,Device Safety, Medical,Safety, Medical Device,Equipment Hazard,Equipment Hazards,Hazard, Equipment,Safety, Device
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017147 Defibrillators, Implantable Implantable devices which continuously monitor the electrical activity of the heart and automatically detect and terminate ventricular tachycardia (TACHYCARDIA, VENTRICULAR) and VENTRICULAR FIBRILLATION. They consist of an impulse generator, batteries, and electrodes. Cardioverter-Defibrillators, Implantable,Implantable Cardioverter Defibrillator,Implantable Cardioverter-Defibrillators,Implantable Defibrillators,Cardioverter Defibrillator, Implantable,Cardioverter Defibrillators, Implantable,Cardioverter-Defibrillator, Implantable,Defibrillator, Implantable,Defibrillator, Implantable Cardioverter,Defibrillators, Implantable Cardioverter,Implantable Cardioverter Defibrillators,Implantable Cardioverter-Defibrillator,Implantable Defibrillator

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