Magnetic Resonance Imaging in patients with ICDs and Pacemakers



Prashant Nair, Ariel Roguin,                                                      199

“Magnetic Resonance Imaging in patients with ICDs and Pacemakers”

Table 1: Potential effects of MR imaging on pacemaker and ICD systems

1. Static Magnetic Field
Mechanical forces on ferromagnetic components
Unpredictable magnetic sensor activation, Reed-switch closure
Changes in electrocardiograms

2. Modulated Radio Frequency (RF) Field

Heating of cardiac tissue adjacent to lead electrodes

Possible induction of life-threatening arrhythmias

Pacemaker reprogramming or reset

RF interactions with the device (over- and under-sensing)

3. Gradient Magnetic Field
Possible induction of life-threatening arrhythmias
Induced voltages on leads cause over- and under-sensing

4. Combined Field Effects
Alteration of device function due to EMI
Mechanical forces (vibration)
Electronic reset of device

Supporting the current practice comes from several reported lethal consequences of MR
imaging in patients with implanted pacemakers
1315. During the late 1980s incidentally 10 deaths
have been attributed to MR procedures in patients with pacemakers. However these fatalities
were poorly characterized and no electrocardiographic data were available. Most importantly no
deaths have been reported during physician supervised MR procedures in the last decade.

Despite the above-mentioned concerns, the effects of MR on cardiac pacemakers remain
controversial. Most of the previous studies that prohibit MR in pacemaker patients were based on
in vitro and animal model data in the 1980’s using older pacemaker and lead technology. During
the last decade, anecdotal reports describe a small series
16-21 of pacemaker patients who have
safely undergone magnetic resonance scanning (
Table 2). Advance in device technology drove
extensive and seminal in-vitro and animal studies of the pacemaker and ICD systems interaction
with the MR, and in recent years, several groups scanned safely larger number of patients.

Table 2: Published reports describing the non-lethal consequences of magnetic resonance
imaging n pacemaker patients (n=number of patients studied; n.a.=data not available;
PM=pacemaker;T=Tesla)

Aulhor

Ref Tear її Indrzation for WRJ

Pacemakei

Mo⅛l

T1IialGinglf

Chamber

Lead

PuLirily

TM—
inode

Field Outcome after MRI

rtt⅜u⅜th         ________________

'A1⅞r∣ιiT

^Tu 1989 1 Eiii∑ι turner

-⅛F7

Dual

Uiiipolai

OOD

1.5 T ItonnaI

Inb ⅞ι

~I7 15ЯЗ І CsAfllopDrtiite
jy⅛l⅛nte

Parajon ∏

Dual

Bipolar

000

1.5 T Normal

GinAtl

IS 1996 1 Heirt valve

AFT

Single

Unipolar

000

1.5 T Image artifact

1 Braut turner

Genesb

Dual

Unipolar

DOG

0.5 T Pawe(Ss)

! CIA

ParagonlI

Dual

Bipolar

000

0.33 T Nontuil

1 PitutaiytuJUDr

Synchrony

Dual

Bipolar

DOO

1.5 T Noimal

1 ⅛¾al⅛i

Sywkrary
II

Dual

Bipoki

DDD

1.0 T Ntrmal

Fortune

19      1998 1     r∣iτ∑d∏p-;-;

TheiaDR

Dual

Bipolar

VVI

і 5 T Rapaiventpacing

G*κb

Бсііо

20 IWS 3 Lrannlttefflptby

МЙ*

Dwd

Bipolar

AOO

IOT А*укк»іівцз pacin(

Sotnnter

21    1998 13 CNS

Elite

Dual

NA

DDI'

0.5 T Asynchronous pacing

Cihliij Twtiar

Elik

Dual

NA

DDD

0.5 T AsyftjkitnauspacBig

Peκpιostlteti':
(arc aorta)

Elite

Dual

HA

DDD

0.5 T Asynchronous pacing

Fs⅛doanewysm

Relay

Dual

NA

VOO

0.5 T Nonttal

Faiavalvar Prosth

Visia

Dual

NA

DDE

0.5 T Asynchronous pacing

Coiuhictive

Pencarbtii

Dialof

Single

NA

VVI

Q .5 T Asyικhκuwιs pacing

Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 5(3): 197-209 (2005)



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