Heating of pacemaker leads during magnetic resonance imaging: reply

Aarhus University Hospital, Aarhus, Central Jutland, Denmark
European Heart Journal (Impact Factor: 15.2). 03/2005; 26(4):376-83; discussion 325-7. DOI: 10.1093/eurheartj/ehi009
Source: PubMed


Magnetic resonance imaging (MRI) is well established as an important diagnostic tool in medicine. However, the presence of a cardiac pacemaker is usually regarded as a contraindication for MRI due to safety reasons. In this study, heating effects at the myocardium-pacemaker lead tip interface have been investigated in a chronic animal model during MRI at 1.5 Tesla.
Pacemaker leads with additional thermocouple wires as temperature sensors were implanted in nine animals. Temperature increases of up to 20 degrees C were measured during MRI of the heart. Significant impedance and minor stimulation threshold changes could be seen. However, pathology and histology could not clearly demonstrate heat-induced damage.
MRI may produce considerable heating at the lead tip. Changes of pacing parameters due to MRI could be seen in chronic experiments. Potential risk of tissue damage cannot be excluded even though no reproducible alterations at the histological level could be found.

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Available from: Erik Morre Pedersen
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    • "Temperature changes were found to a maximum of 45.9°C at the lead tip with a 1.5-T scan [23]. Animal studies evaluated local tissue heating with a peak SAR set to 3.8 W/kg [24] and found no evidence of tissue necrosis at post-scan necropsy. Although MRI of the head and lumbar regions at 1.5 T had temperature changes ≤ 0.5°C [25], it has been recognized that the lead lengths (the longer, the higher) and position (more in the right than in the left hemithorax) will affect temperature changes with the highest temperatures being at the tip of the ventricular electrode [26,27]. "
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    ABSTRACT: Background Conventional 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. Methods We 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. Results All 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. Conclusions This 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.
    Full-text · Article · Jun 2014 · Journal of Cardiovascular Magnetic Resonance
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    • "This may produce pacemaker reset, battery depletion, and adverse effects on sensing, pacing thresholds, and lead impedances, causing inappropriate pacing acceleration or inhibition.10,25 Abandoned or fractured leads are especially prone to tip heating.26,27 "
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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.
    Full-text · Article · May 2014 · Medical Devices: Evidence and Research
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    • "Subsequent thermal damage around the lead tip includes oedema or formation of scar tissue. In both situations, an increase in pacing thresholds or even complete loss of capture may occur [10]. "
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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.
    Full-text · Article · Apr 2014 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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