Safety of Serial MRI in Patients With Implantable Cardioverter Defibrillators

OBJECTIVES: While patients with cardiac implantable electronic devices could benefit from magnetic resonance (MR) imaging, the presence of such devices has been designated as an absolute contraindication to MR. Although scanning algorithms are proposed for cardiac implantable electronic devices, their safety remains uncertain. To address this issue, the safety of serial cardiac MR scans was evaluated in patients with implantable cardioverter defibrillators (ICDs).

METHODS: Three serial cardiac MR scans were prospectively performed at 1.5 T on 10 patients (9 men) of median age 56 years (range 51–68) with ICDs. ICD interrogation was performed before and after the MR scan and at a follow-up of median 370 days (range 274–723). Image quality was also assessed.

RESULTS: In all patients MR scanning occurred without complications. There were no differences between pre- and post-MR pacing capture threshold, pacing lead or high voltage lead impedance, or battery voltage values. During follow-up there were no occurrences of ICD dysfunction. Although most patients had image artifacts, the studies were generally diagnostic regarding left ventricular function and wall motion. Delayed enhancement imaging was of good quality for inferior wall and inferolateral infarcts, but ICD artifacts often affected the imaging of anterior wall infarcts.

CONCLUSIONS: Serial MR scans at 1.5 T in patients with ICDs, when carefully performed in a monitored setting, have no adverse effects on either patient or device. When required, single or multiple MR scans at 1.5 T may therefore be considered for clinical diagnostic purposes in these patients.

PMID:

Jacobo Kirsch

Associate Center Director, Imaging Institute
Cardiopulmonary Imaging, Section Head
Cleveland Clinic Florida
Weston, FL
Posted in Magnetic Resonance Imaging and tagged , , , .

3 Comments

  1. Compare with:

    Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance.
    Levine GN, Gomes AS, Arai AE, Bluemke DA, Flamm SD, Kanal E, Manning WJ, Martin ET, Smith JM, Wilke N, Shellock FS; A.
    Circulation. 2007 Dec 11;116(24):2878-91.
    PMID: 18025533

  2. In my mind, the strength of the paper is that the studies were performed with the magnet isocenter over the heart… Which makes me think: shouldn’t we worry even more if the isocenter lies over the actual pacer device and its battery? Or just about the leads?

    Thoughts?

  3. Were there animal experiments before this?
    Will 370 days (range 274–723) be enough to draw conclusions?
    Should we test more patients?
    Will you accept that, if you are a patient?
    Why is echo not enough? Why use MR?
    How could patients benefit from magnetic resonance (MR) imaging?
    Live longer with spending more money?

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