Magnetic resonance imaging in patients with cardiac implantable electronic devices : safety and image quality

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Recently, several extensive studies have shown that magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) can be performed safely if a dedicated safety protocol is followed. Still, there is a lack of comprehensive data on MRI safety in certain subgroups of CIED patients, such as patients with epicardial pacing leads and patients requiring temporary pacing. MRI examinations in CIED patients have been performed at Meilahti Helsinki University Hospital (HUH) since 2011 following the HUH’s MRI in CIED patients safety protocol. Patients with abandoned pacing leads and epicardial pacing leads have been permitted in MRI after a case-by-case evaluation. This study aimed to investigate the MRI safety and image quality (IQ) in CIED patients at HUH between November 2011 and October 2019. During the study timeframe, 2338 MRI examinations were performed on CIED patients. Several relevant observations were made. Firstly, the first 1000 MRI scans at HUH were performed safely, and only one potentially catastrophic adverse event was noted. This was due to an unintended change in the pacing mode during MRI in a pacemaker-dependent patient. Secondly, no harm was detected related to MRI in CIED patients with modern (implanted in 2000 or later) functioning epicardial pacing leads. One definite adverse event – a transient elevation of the pacing threshold – related to the MRI was noted in a patient with an old functioning epicardial pacing lead (implanted before the year 2000). Thirdly, this study revealed that cardiac magnetic resonance (CMR) imaging can be performed without adverse events in patients presenting with bradycardic atrioventricular block (AVB) requiring urgent pacing using an active fixation pacing lead connected to an extracorporeal generator (temporary permanent pacemaker [TPPM]). The CMR IQ remained diagnostic, and the myocardial disease screening in this population revealed granulomatous inflammatory cardiac disease in 47.1% of the patients. Lastly, we found that a right-sided generator implantation reduced the CIED-induced artefacts overlaying the left ventricular myocardium on the CMR images compared to a left-sided generator implantation. In patients with a left-sided generator, raising the arm on the side of the generator during the CMR scanning improved the IQ in several sequences compared to an ‘arm-down’ scanning. In conclusion, MRI in CIED patients can be performed safely by following the dedicated safety protocol. Additionally, MRI may be safe in patients with modern functioning epicardial pacing leads. The CMR-based myocardial disease screening in patients with AVB using TPPM is safe, and the IQ remains diagnostic. The arm-raised CMR scanning position may improve the IQ in patients with a left-sided generator.
  • Kivistö, Sari Marjut, Handledare
  • Holmström, Miia Maria, Handledare
  • Kaasalainen, Touko Tuomas, Handledare
Tryckta ISBN978-951-51-8775-8
Elektroniska ISBN978-951-51-8776-5
StatusPublicerad - 2023
MoE-publikationstypG5 Doktorsavhandling (artikel)

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  • 3126 Kirurgi, anestesiologi, intensivvård, radiologi

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