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Safety of magnetic resonance imaging in patients with permanent pacemakers: a collaborative clinical approach

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Objective

This study aimed to characterize the interactions of pacemakers with magnetic resonance imaging (MRI) and to identify device characteristics that could predict adverse interactions.

Background

The safety of MRI in patients with indwelling pacemaker systems remains uncertain. Previous studies demonstrated safety in most patients, but unpredictable, potentially concerning changes in pacemaker behavior have occurred.

Methods

We prospectively studied patients with pacemaker devices in situ who were not pacemaker dependent and in whom MRI was essential for adequate diagnosis and treatment. All patients were monitored by electrocardiography and pulse oximetry during scanning; devices were interrogated and cardiac enzymes were measured before and after scanning.

Results

Of 32 patients studied (46 MRI examinations), 28 patients had a dual-chamber system and one had a biventricular device. Regions scanned were the head and spine. Devices were reprogrammed to asynchronous pacing or sense-only mode in all except six patients before MRI. During six scanning episodes (five patients), “power-on” resetting of the device was noted. Magnet-mode pacing was noted during four episodes (three patients). Occasional premature ventricular contractions were noted in one patient. No significant changes in battery voltage, sensed P wave and R wave, pacing thresholds, lead impedance, or cardiac enzymes were noted immediately after MRI or at 1-month follow-up.

Conclusions

Overall, no significant changes were seen in pacemaker device function, and no adverse clinical events were observed. A minority of patients with older devices had unpredictable changes in device behavior, which stresses the need for close monitoring during and careful device interrogation after scanning.

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Abbreviations

CIED:

Cardiac implantable electronic device

FDA:

US Food and Drug Administration

ICD:

Implantable cardioverter defibrillator

MRI:

Magnetic resonance imaging

POR:

Power-on resetting

References

  1. Duru, F., Luechinger, R., Scheidegger, M. B., Luscher, T. F., Boesiger, P., & Candinas, R. (2001). Pacing in magnetic resonance imaging environment: Clinical and technical considerations on compatibility. European Heart Journal, 22, 113–124.

    Article  PubMed  CAS  Google Scholar 

  2. Duru, F., Luechinger, R., & Candinas, R. (2001). MR imaging in patients with cardiac pacemakers. Radiology, 219, 856–858.

    PubMed  CAS  Google Scholar 

  3. Helfer, J. L., Gray, R. W., MacDonald, S. G., & Bibens, T. W. (2006). Can pacemakers, neurostimulators, leads, or guide wires be MRI safe? Technological concerns and possible resolutions. Minimally Invasive Therapy & Allied Technologies, 15, 114–120.

    Article  Google Scholar 

  4. Shinbane, J. S., Colletti, P. M., & Shellock, F. G. (2007). MR in patients with pacemakers and ICDs: Defining the issues. Journal of Cardiovascular Magnetic Resonance, 9, 5–13.

    Article  PubMed  Google Scholar 

  5. Stevenson, B., Dabney, W., & Frysz, C. (2007). Issues and design solutions associated with performing MRI scans on patients with active implantable medical devices. Conference Proceedings—IEEE Engineering in Medicine and Biology Society, 2007, 6167–6170.

    Google Scholar 

  6. Kalin, R., & Stanton, M. S. (2005). Current clinical issues for MRI scanning of pacemaker and defibrillator patients. Pacing and Clinical Electrophysiology, 28, 326–328.

    Article  PubMed  Google Scholar 

  7. Levine, G. N., Gomes, A. S., Arai, A. E., et al. (2007). 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. Circulation, 116, 2878–2891.

    Article  PubMed  Google Scholar 

  8. Levine, P. A. (2005). Industry viewpoint: St. Jude Medical: Pacemakers, ICDs and MRI. Pacing and Clinical Electrophysiology, 28, 266–267.

    Article  PubMed  Google Scholar 

  9. Smith, J. M. (2005). Industry viewpoint: Guidant: Pacemakers, ICDs, and MRI. Pacing and Clinical Electrophysiology, 28, 264.

    Article  PubMed  Google Scholar 

  10. Stanton, M. S. (2005). Industry viewpoint: Medtronic: Pacemakers, ICDs, and MRI. Pacing and Clinical Electrophysiology, 28, 265.

    Article  PubMed  Google Scholar 

  11. Faris, O. P., & Shein, M. (2006). Food and Drug Administration perspective: Magnetic resonance imaging of pacemaker and implantable cardioverter-defibrillator patients. Circulation, 114, 1232–1233.

    Article  PubMed  Google Scholar 

  12. Naehle, C. P., Sommer, T., Meyer, C., et al. (2006). Strategy for safe performance of magnetic resonance imaging on a patient with implantable cardioverter defibrillator. Pacing and Clinical Electrophysiology, 29, 113–116.

    Article  PubMed  Google Scholar 

  13. Sommer, T., Naehle, C. P., Yang, A., et al. (2006). Strategy for safe performance of extrathoracic magnetic resonance imaging at 1.5 Tesla in the presence of cardiac pacemakers in non-pacemaker-dependent patients: A prospective study with 115 examinations. Circulation, 114, 1285–1292.

    Article  PubMed  Google Scholar 

  14. Luechinger, R., Duru, F., Scheidegger, M. B., Boesiger, P., & Candinas, R. (2001). Force and torque effects of a 1.5-Tesla MRI scanner on cardiac pacemakers and ICDs. Pacing and Clinical Electrophysiology, 24, 199–205.

    Article  PubMed  CAS  Google Scholar 

  15. Luechinger, R., Duru, F., Zeijlemaker, V. A., Scheidegger, M. B., Boesiger, P., & Candinas, R. (2002). Pacemaker reed switch behavior in 0.5, 1.5, and 3.0 Tesla magnetic resonance imaging units: Are reed switches always closed in strong magnetic fields? Pacing and Clinical Electrophysiology, 25, 1419–1423.

    Article  PubMed  Google Scholar 

  16. Luechinger, R., Zeijlemaker, V. A., Pedersen, E. M., et al. (2005). In vivo heating of pacemaker leads during magnetic resonance imaging. European Heart Journal, 26, 376–383. discussion 25–7.

    Article  PubMed  Google Scholar 

  17. Gimbel, J. R., Wilkoff, B. L., Kanal, E., & Rozner, M. A. (2005). Safe, sensible, sagacious: Responsible scanning of pacemaker patients. European Heart Journal, 26, 1683–1684.

    Article  PubMed  Google Scholar 

  18. Gimbel, J. R. (2009). Unexpected asystole during 3T magnetic resonance imaging of a pacemaker-dependent patient with a ‘modern’ pacemaker. Europace, 11, 1241–1242.

    Article  PubMed  Google Scholar 

  19. Mitka, M. (2009). Researchers seek MRI-safe pacemakers. JAMA, 301, 476.

    Article  PubMed  CAS  Google Scholar 

  20. Sutton, R., Kanal, E., Wilkoff, B. L., et al. (2008). Safety of magnetic resonance imaging of patients with a new Medtronic EnRhythm MRI SureScan pacing system: Clinical study design. Trials, 9, 68.

    PubMed  Google Scholar 

  21. Rozner, M. A., Burton, A. W., & Kumar, A. (2005). Pacemaker complication during magnetic resonance imaging. Journal of the American College of Cardiology, 45, 161–162. author reply 2.

    Article  PubMed  Google Scholar 

  22. Nazarian, S., Roguin, A., Zviman, M. M., et al. (2006). Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable-cardioverter defibrillators at 1.5Tesla. Circulation, 114, 1277–1284.

    Article  PubMed  Google Scholar 

  23. Naehle, C. P., Strach, K., Thomas, D., et al. (2009). Magnetic resonance imaging at 1.5-T in patients with implantable cardioverter-defibrillators. Journal of the American College of Cardiology, 54, 549–555.

    Article  PubMed  Google Scholar 

  24. Mollerus, M., Albin, G., Lipinski, M., & Lucca, J. (2008). Cardiac biomarkers in patients with permanent pacemakers and implantable cardioverter-defibrillators undergoing an MRI scan. Pacing and Clinical Electrophysiology, 31, 1241–1245.

    Article  PubMed  Google Scholar 

  25. Jilek, C., Tzeis, S., Reents, T., et al. (2010). Safety of implantable pacemakers and cardioverter defibrillators in the magnetic field of a novel remote magnetic navigation system. Journal of Cardiovascular Electrophysiology, 21, 1136–1141.

    Article  PubMed  Google Scholar 

  26. Irnich, W., Irnich, B., Bartsch, C., Stertmann, W. A., Gufler, H., & Weiler, G. (2005). Do we need pacemakers resistant to magnetic resonance imaging? Europace, 7, 353–365.

    Article  PubMed  Google Scholar 

  27. Goldsher, D., Amikam, S., Boulos, M., et al. (2006). Magnetic resonance imaging for patients with permanent pacemakers: Initial clinical experience. The Israel Medical Association Journal, 8, 91–94.

    PubMed  Google Scholar 

  28. Roguin, A., Zviman, M. M., Meininger, G. R., et al. (2004). Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: In vitro and in vivo assessment of safety and function at 1.5 T. Circulation, 110, 475–482.

    Article  PubMed  Google Scholar 

  29. Shellock, F. G., Fischer, L., & Fieno, D. S. (2007). Cardiac pacemakers and implantable cardioverter defibrillators: In vitro magnetic resonance imaging evaluation at 1.5-Tesla. Journal of Cardiovascular Magnetic Resonance, 9, 21–31.

    Article  PubMed  Google Scholar 

  30. Roguin, A., Schwitter, J., Vahlhaus, C., et al. (2008). Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices. Europace, 10, 336–346.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the assistance of Nicholas E. Payne RN and Jeff Burrows (Medtronic, Minneapolis, MN, USA) and Gene A. Bornzin, Ph.D. (St. Jude Medical, Sylmar, CA, USA) for their technical and engineering advice in the preparation of this manuscript.

Disclosures

Dr. Friedman is involved in sponsored research with Medtronic, Boston Scientific, Bard, St. Jude Medical, and Pfizer; has intellectual property rights with Bard EP, Hewlett Packard, Medical Positioning, Inc., Aegis Medical, and NeoChord; and has spoken for and/or consulted for Medtronic, Boston Scientific, and St. Jude Medical. David L. Hayes serves as a member of the advisory board for St. Jude Medical, Boston Scientific. He also serves as a speaker at educational venues for St. Jude Medical, Boston Scientific, Sorin Medical, Biotronik, and Medtronic. Dr. Shen receives funding from Medtronic for an investigator initiated research project.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Barry Anthony Boilson, Anita Wokhlu, Nancy G. Acker, Paul A. Friedman, Yong-Mei Cha, Robert F. Rea, David L. Hayes & Win-Kuang Shen

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Joel P. Felmlee, Robert E. Watson Jr & Paul R. Julsrud

  3. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA

    Joel P. Felmlee

  4. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Paul R. Julsrud

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  1. Barry Anthony Boilson
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  2. Anita Wokhlu
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Correspondence to Barry Anthony Boilson.

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Boilson, B.A., Wokhlu, A., Acker, N.G. et al. Safety of magnetic resonance imaging in patients with permanent pacemakers: a collaborative clinical approach. J Interv Card Electrophysiol 33, 59–67 (2012). https://doi.org/10.1007/s10840-011-9615-8

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  • DOI: https://doi.org/10.1007/s10840-011-9615-8

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