Magnetic Resonance Imaging and Implantable Devices

Section of Cardiac Electrophysiology, The Johns Hopkins University School of Medicine, Baltimore, MD.
Circulation Arrhythmia and Electrophysiology (Impact Factor: 4.51). 04/2013; 6(2):419-428. DOI: 10.1161/CIRCEP.113.000116
Source: PubMed
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    • "The combination of these two growing phenomena results in an estimated 50%–75% probability of a patient needing an MRI over the lifetime of the device.6 These patients will generally see their MRI studies denied due to safety concerns.7–9 This “clash of technologies” thus creates a paradoxical effect in which application of a useful technique is limited by the presence of another technology in the same patient.10 "
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    ABSTRACT: Use of both magnetic resonance imaging (MRI) and pacing devices has undergone remarkable growth in recent years, and it is estimated that the majority of patients with pacemakers will need an MRI during their lifetime. These investigations will generally be denied due to the potentially dangerous interactions between cardiac devices and the magnetic fields and radio frequency energy used in MRI. Despite the increasing reports of uneventful scanning in selected patients with conventional pacemakers under close surveillance, MRI is still contraindicated in those circumstances and cannot be considered a routine procedure. These limitations prompted a series of modifications in generator and lead engineering, designed to minimize interactions that could compromise device function and patient safety. The resulting MRI-conditional pacemakers were first introduced in 2008 and the clinical experience gathered so far supports their safety in the MRI environment if certain conditions are fulfilled. With this technology, new questions and controversies arise regarding patient selection, clinical impact, and cost-effectiveness. In this review, we discuss the potential risks of MRI in patients with electronic cardiac devices and present updated information regarding the features of MRI-conditional pacemakers and the clinical experience with currently available models. Finally, we provide some guidance on how to scan patients who have these devices and discuss future directions in the field.
    Medical Devices: Evidence and Research 05/2014; 7(1):115-124. DOI:10.2147/MDER.S44063
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    • "When the MRI examination is finished, the original settings of the CIED should be restored after confirming that these are still safe and provide adequate margins. In order to exclude any late side effects or symptoms, a control visit (3–6 months after the scan) to the outpatient department may be recommended [25]. "
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    ABSTRACT: 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.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 04/2014; 22(6). DOI:10.1007/s12471-014-0544-x · 1.84 Impact Factor
  • Heart rhythm: the official journal of the Heart Rhythm Society 10/2013; 10(12). DOI:10.1016/j.hrthm.2013.10.050 · 5.08 Impact Factor
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