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
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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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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