Abstract
Magnetic resonance imaging (MRI) of patients with pacemakers remains concerning because of possible magnetic field effects on the device. Many pacemaker models are labeled as non-conditional, or contraindicated for MRI, or do not have any specific safety guidelines listed. This study describes our experience with pacemaker function and adverse events in pediatric and young adult patients after clinically indicated MRI scanning at 1.5 Tesla (T). We hypothesized that generator battery voltage, pacemaker lead threshold, and lead impedance would not be altered by MRI. This was a retrospective review of Children’s Wisconsin clinical MRI data for all patients with pacemakers scanned between January 1, 2010 and March 31, 2018. Pacemakers were interrogated by the Electrophysiology Team before and immediately after MRI and at outpatient follow up. Twenty-one patients underwent forty-four MRI scans. No significant immediate changes were seen in any pacemaker parameter for any manufacturer/model/lead at the time of MRI. At first clinical follow up post MRI, (median 4.4 months, range 0.2–12.3), battery voltage was reduced (2.78 V pre-MRI versus 2.77 V at follow up, p = 0.02), but there were no other significant changes. No adverse events were noted. Pediatric patients with pacemakers, including those with epicardial leads, can be scanned at 1.5 T safely without alteration in pacemaker function. Using appropriate precautions, pediatric patients with pacemakers can be imaged with MRI.
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References
Kiblboeck D, Reiter C, Kammler J et al (2018) Artefacts in 1.5 Tesla and 3 Tesla cardiovascular magnetic resonance imaging in patients with leadless cardiac pacemakers. J Cardiovasc Magn Reson 20(1):47. https://doi.org/10.1186/s12968-018-0469-4
US Food and Drug Administration (2019) Benefits and risks. https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MRI/ucm482765.htm. Accessed 18 Feb 2019
Gopinathannair R, Mar PL, Gandhi G et al (2017) 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 14(7):e97–153. https://doi.org/10.1111/pace.13503
Pulver AF, Puchalski MD, Bradley DJ et al (2009) Safety and imaging quality of MRI in pediatric and adult congenital heart disease patients with pacemakers. Pacing Clin Electrophysiol 32(4):(4):450–383–456. https://doi.org/10.1111/j.1540-8159.2009.02304.x
Kodali S, Baher A, Shah D (2013) Safety of MRIs in patients with pacemakers and defibrillators. Methodist Debakey Cardiovasc J 9(3):137–141
Shellock FG (2019) Reference manual for magnetic resonance safety, implants, and devices: 2019 Edition. www.mrisafetybook.com
Yadava M (2018) Magnetic resonance imaging and cardiac devices. N Engl J Med 378(17):1652–1653. https://doi.org/10.1056/NEJMc1802623
Krebsbach A, Dewland TA, Henrikson CA (2016) Malfunction of an MRI-conditional pacemaker following an MRI. Heart Rhythm Case Rep 3:148–150
Indik JH, Gimbel JR, Abe H et al (2017) 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 14(7):e97–153. https://doi.org/10.1016/j.hrthm.2017.04.025
Roguin A, Zviman MM, Meininger GR 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(5):475–482. https://doi.org/10.1161/01.CIR.0000137121.28722.33
Luechinger R, Zeijlemaker VA, Pedersen EM et al (2005) In vivo heating of pacemaker leads during magnetic resonance imaging. Eur Heart J 26(4):376–383. https://doi.org/10.1093/eurheartj/ehi009
Nazarian S, Hansford R, Rahsepar AA et al (2017) Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med 377(26):2555–2564. https://doi.org/10.1056/NEJMoa1604267
Shah AD, Morris MA, Hirsh DS et al (2018) Magnetic resonance imaging safety in nonconditional pacemaker and defibrillator recipients: a meta-analysis and systematic review. Heart Rhythm 15(7):1001–1008. https://doi.org/10.1016/j.hrthm.2018.02.019
Blissett S, Chetrit M, Kovacina B, Mardigyan V, Afilalo J (2018) Performing cardiac magnetic resonance imaging in patients with cardiac implantable electronic devices: a contemporary review. Can J Cardiol 34(12):1682–1686. https://doi.org/10.1016/j.cjca.2018.09.009
Beinart R, Nazarian S (2012) Magnetic resonance imaging in patients with implanted devices. J Cardiovasc Electrophysiol 23(9):1040–1042. https://doi.org/10.1111/j.1540-8167.2012.02366.x
Funding
This study had no extramural grant funding. The Department of Pediatrics, Medical College of Wisconsin, though, provided funding for work performed by Madeline Bireley, as a Summer Research Program participant.
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Bireley, M., Kovach, J.R., Morton, C. et al. Cardiac Magnetic Resonance Imaging (MRI) in Children is Safe with Most Pacemaker Systems, Including Those with Epicardial Leads. Pediatr Cardiol 41, 801–808 (2020). https://doi.org/10.1007/s00246-020-02316-z
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DOI: https://doi.org/10.1007/s00246-020-02316-z