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Safety of Implanted Cardiac Devices in an MRI Environment

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Magnetic resonance imaging (MRI) has evolved into an essential diagnostic modality for the evaluation of various conditions. In line with the increase in MRI applications, the use of cardiac implantable electronic devices (CIED) is growing and many of the CEID recipients of today may require MRI examinations in the future. Traditionally, MRI examination of CIED recipients has been considered a contraindication. However, recent studies have provided strong evidence that MRI can safely be performed in selected patients with specific precautions. This review highlights the interactions of MRI with CIEDs, summarizes the literature, and outlines the Johns Hopkins Safety Protocol.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009—a World Society of Arrhythmia’s Project. Pacing Clin Electrophysiol. 2011;34:1013–27.

    Article  PubMed  Google Scholar 

  2. Kalin R, Stanton MS. Current clinical issues for MRI scanning of pacemaker and defibrillator patients. Pacing Clin Electrophysiol: PACE. 2005;28:326–8.

    Article  PubMed  Google Scholar 

  3. Martin ET, Coman JA, Shellock FG, et al. Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla. J Am Coll Cardiol. 2004;43:1315–24.

    Article  PubMed  Google Scholar 

  4. Roguin A, Zviman MM, Meininger GR, et al. 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. 2004;110:475–82.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Nazarian S, Roguin A, Zviman MM, et al. Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable cardioverter defibrillators at 1.5 Tesla. Circulation. 2006;114:1277–84.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices. Circulation. 2007;116:2878–91.

    Article  PubMed  Google Scholar 

  7. Fetter J, Aram G, Holmes Jr DR, et al. The effects of nuclear magnetic resonance imagers on external and implantable pulse generators. Pacing Clin Electrophysiol. 1984;7(4):720–7.

    Article  CAS  PubMed  Google Scholar 

  8. Nazarian S, Halperin HR. How to perform magnetic resonance imaging on patients with implantable cardiac arrhythmia devices. Heart Rhythm. 2009;6:138–43.

    Article  PubMed  Google Scholar 

  9. Luechinger R, Duru F, Scheidegger MB, et al. Force and torque effects of a 1.5 Tesla MRI scanner on cardiac pacemakers and ICD’s. Pacing Clin Electrophysiol. 2001;24:199–205.

    Article  CAS  PubMed  Google Scholar 

  10. Luechinger R, Zeijlemaker VA, Pederson EM, et al. In vivo heating of pacemaker leads during magnetic resonance imaging. Eur Heart J. 2004;26:376–83.

    Article  PubMed  Google Scholar 

  11. Luechinger R, Duru F, Zeijlemaker VA, et al. 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 Clin Electrophysiol. 2002;25:1419–23.

    Article  PubMed  Google Scholar 

  12. Nazarian S, Hansford R, Roguin A, et al. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med. 2011;155:415–24.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Coman JA, Martin ET, Sandler DA, et al. Implantable cardiac defibrillator interactions with magnetic resonance imaging at 1.5 Tesla. J Am Coll Cardiol. 2004;43:138A.

    Article  Google Scholar 

  14. Nazarian S, Beinart R, Halperin HR. Magnetic resonance imaging and implantable devices. Circ Arrhythm Electrophysiol. 2013;6(2):419–28.

    Article  CAS  PubMed  Google Scholar 

  15. Ainslie M, Miller C, Brown B, et al. Cardiac MRI of patients with implanted electrical cardiac devices. Heart. 2013;0:1–7.

  16. Gimbel JR, Johnson D, Levine PA, et al. Safe performance of magnetic resonance imaging on five patients with permanent cardiac pacemakers. Pacing Clin Electrophysiol. 1996;19(6):913–9.

    Article  CAS  PubMed  Google Scholar 

  17. Fontaine JM, Mohamed FB, Gottlieb C, et al. Rapid ventricular pacing in a pacemaker patient undergoing magnetic resonance imaging. Pacing Clin Electrophysiol. 1998;21:1336–9.

    Article  CAS  PubMed  Google Scholar 

  18. Sommer T, Vahlhaus C, Lauck G, et al. MRI and cardiac pacemakers: in-vitro evaluation and in vivo studies in 51 patients at 0.5 T. Radiology. 2000;215:869–79.

    Article  CAS  PubMed  Google Scholar 

  19. Vahlhaus C, Sommer T, Lewalter T, et al. Interference with cardiac pacemakers by magnetic resonance imaging: are there irreversible changes at 0.5 T? Pacing Clin Electrophysiol. 2001;24:489–95.

    Article  CAS  PubMed  Google Scholar 

  20. Gimbel JR, Bailey SM, Tchou PJ, et al. Strategies for the safe magnetic resonance imaging of pacemaker-dependent patients. Pacing Clin Electrophysiol. 2005;28:1041–6.

    Article  PubMed  Google Scholar 

  21. Del Ojo JL, Moya F, Villalba J, et al. Is magnetic resonance imaging safe in cardiac pacemaker recipients? Pacing Clin Electrophysiol. 2005;28:274–8.

    Article  PubMed  Google Scholar 

  22. Kaasalainen T, Pakarinen S, Kivistö S, et al. MRI with cardiac pacing devices—safety in clinical practice. Eur J Radiol. 2014;83(8):1387–95. This is one of the most recent studies that evaluated the safety results of both MRI conditional and MRI unsafe devices in clinical practice. Out of 64 patients, 22 had MRI conditional CIED. There were no MRI related complications or clinically significant changes in system parameters following MRI examination.

    Article  PubMed  Google Scholar 

  23. Naehle CP, Strach K, Thomas D, et al. Magnetic resonance imaging at 1.5-T in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol. 2009;54(6):549–55.

    Article  PubMed  Google Scholar 

  24. Mollerus M, Albin G, Lipinski M, et al. Magnetic resonance imaging of pacemakers and implantable cardioverter-defibrillators without specific absorption rate restrictions. Europace. 2010;12(7):947–51.

    Article  PubMed  Google Scholar 

  25. Junttila MJ, Fishman JE, Lopera GA, et al. Safety of serial MRI in patients with implantable cardioverter defibrillators. Heart. 2011;97:1852–6.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Zikria JF, Machnicki S, Rhim E, et al. MRI of patients with cardiac pacemakers: a review of the medical literature. Am J Roentgenol. 2011;196:390–401.

    Article  Google Scholar 

  27. Cohen JD, Costa HS, Russo RJ. Determining the risks of magnetic resonance imaging at 1.5 Tesla for patients with pacemakers and implantable cardioverter defibrillators. Am J Cardiol. 2012;110:1631–6. This study is the first to use control group who had CIED and did not undergo MRI. Interestingly, there were no significant difference between groups that may indicate that minor changes in system parameters may be due to MRI related interaction, or may reflect normal variation/fluctuation over time. But one major limitation was the retrospective design of the study.

    Article  PubMed  Google Scholar 

  28. Russo RJ. Determining the risks of clinically indicated nonthoracic magnetic resonance imaging at 1.5 T for patients with pacemakers and implantable cardioverter-defibrillators: rationale and design of the MagnaSafe Registry. Am Heart J. 2013;165:266–72. MagnaSafe Registry is an ongoing randomized trial that targets to perform 1500 MRI to non-MRI conditional CIED recipients. As of 2013, 1189 patients were enrolled. So far no deaths or severe complication were reported. However, clinically relevant device parameter changes and partial electrical resets have been observed in minority of the cases. This study will be completed in the near future and will add more information in regard to MRI safety in patients with non-MRI conditional CIED.

    Article  PubMed  Google Scholar 

  29. Roguin A, Schwitter J, Vahlhaus C, et al. Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices. Europace. 2008;10:336–46.

    Article  PubMed  Google Scholar 

  30. Kanal E, Barkovich AJ, Bell C, et al. ACR Blue Ribbon Panel on MR safety. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol. 2007;188:1447–74.

    Article  PubMed  Google Scholar 

  31. Wilkoff BL, Bello D, Taborsky M, et al. Magnetic resonance imaging in patients with a pacemaker system designed for the magnetic resonance environment. Heart Rhythm. 2011;8:65–73.

    Article  PubMed  Google Scholar 

  32. Forleo GB, Santini L, Della Rocca DG, et al. Safety and efficacy of a new magnetic resonance imaging-compatible pacing system: early results of a prospective comparison with conventional dual- chamber implant outcomes. Heart Rhythm. 2010;7:750–4.

    Article  PubMed  Google Scholar 

  33. Gimbel JR, Bello D, Schmitt M, et al. Randomized trial of pacemaker and lead system for safe scanning at 1.5 Tesla. Heart Rhythm. 2013;10:685–91. In this prospective randomized multicenter trial, another MRI conditional device was proved to be safe for 1.5 T MRI. Due to favorable results of this trial, Advisa SureScan MRI pacemaker system was approved by FDA.

    Article  PubMed  Google Scholar 

  34. Wollmann CG, Thudt K, Kaiser B, et al. Safe performance of magnetic resonance of the heart in patients with magnetic resonance conditional pacemaker systems: the safety issue of the ESTIMATE study. J Cardiovasc Magn Reson. 2014;16:30. This single center study demonstrated that 1.5 T cardiac MRI is safe for MRI conditional devices. During short term and long term follow-up, there were only minor changes in system parameters.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Langman DA, Goldberg IB, Finn JP, et al. Pacemaker lead tip heating in abandoned and pacemaker-attached leads at 1.5 Tesla MRI. J Magn Reson Imaging. 2011;33:426–31.

    Article  PubMed  Google Scholar 

  36. Sommer T, Naehle CP, Yang A, et al. 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. 2006;114:1285–92.

    Article  PubMed  Google Scholar 

  37. Higgins JV, Gard JJ, Sheldon SH, et al. Safety and outcomes of magnetic resonance imaging in patients with abandoned pacemaker and defibrillator leads. Pacing Clin Electrophysiol. 2014;37(10):1284–90. This study retrospectively evaluated the impact of MRI on retained leads. There were no MRI-related clinical events; although the absence of the tissue damage was not histopathologically confirmed. Out of 19 patients, 12 had their leads reconnected to a generator after MRI examination; in this subgroup of cases, lead parameters did not show any clinically significant difference.

    Article  PubMed  Google Scholar 

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Acknowledgments

Saman Nazarian is supported by NIH Grants K23HL089333 and R01HL116280.

The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Conflict of Interest

Dr. Esra Gucuk Ipek declares that she has no conflict of interest.

Dr. Saman Nazarian is PI for research funding to Johns Hopkins University from Biosense Webster Inc. and is also a scientific advisor to Biosense Webster Inc. and Medtronic Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Saman Nazarian.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Ipek, E.G., Nazarian, S. Safety of Implanted Cardiac Devices in an MRI Environment. Curr Cardiol Rep 17, 51 (2015). https://doi.org/10.1007/s11886-015-0605-9

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  • DOI: https://doi.org/10.1007/s11886-015-0605-9

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