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EHRA Key References on Safety of magnetic resonance imaging in patients with cardiovascular devices

Latest update 2013 December

Arrhythmias and Device Therapy
Cardiac Magnetic Resonance


2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task
force on cardiac pacing and resynchronization therapy of the European Society of
Cardiology (ESC). Developed in collaboration with the European Heart Rhythm
Association (EHRA). European Society of Cardiology (ESC).

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G,Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW,Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE Europace. 2013 Aug;15(8):1070-118.

The latest guideline on cardiac pacing and resynchronization therapy, including safety precautions for magnetic resonance imaging in patients with conventional cardiac devices.

Magnetic resonance imaging in patients with a pacemaker system designed for the magnetic resonance environment.

Wilkoff BL, Bello D, Taborsky M, Vymazal J, Kanal E, Heuer H, Hecking K, Johnson WB, Young W, Ramza B, Akhtar N, Kuepper B, Hunold P, Luechinger R, Puererfellner H, Duru F, Gotte MJ, Sutton R, Sommer T; EnRhythm MRI SureScan Pacing System Study Investigators. Heart Rhythm.2011 Jan;8(1):65-73.
This prospective, randomized, multicenter study documented the ability of  specially designed dual-chamber pacemaker and lead system to be exposed in a controlled fashion to MRI in a 1.5 T scanner without adverse impact on patient outcomes or pacemaker system function.

Cardiac magnetic resonance imaging at 1.5 T in patients with cardiac rhythm devices.

Buendía F, Cano Ó, Sánchez-Gómez JM, Igual B, Osca J, Sancho-Tello MJ, OlagüeJ, Salvador A. Europace. 2011 Apr;13(4):533-8.

The final results of the study suggest that cardiac MRI can be performed safely in selected patients with pacemaker and/or ICD, including pacemaker dependent cases as well.

Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T.

 Naehle CP, Kreuz J, Strach K, Schwab JO, Pingel S, Luechinger R, Fimmers R,Schild H, Thomas D. Am Heart J. 2011 Jun;161(6):1096-105.

Cardiac MRI maybe performed safely when limiting specific absorption rate, appropriately monitoring patients and following device reprogramming. Image quality in patients with right-sided devices was better the than patients with left sided devices.

Determining the risks of magnetic resonance imaging at 1.5 tesla for patients with pacemakers and implantable cardioverter defibrillators.

Cohen JD, Costa HS, Russo RJ Am J Cardiol. 2012 Dec 1;110(11):1631-6.

In this study, MRI in patients with PM/ICD resulted in no devices or lead failures. Small number of changes in device parameter measurements were noted, however these changes were clinically irrelevant.

Safe magnetic resonance image scanning of the pacemaker patient: current technologies and future directions.

Jung W, Zvereva V, Hajredini B, Jäckle S.  Europace. 2012 May;14(5):631-7.

Excellent summary about guidelines, potential hazards and adverse events associated with magnetic resonance imaging in patients with implanted devices.

Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs.

Shinbane JS, Colletti PM, Shellock FG. J Cardiovasc Magn Reson. 2011 Oct 27;13:63.

The advancement of MR conditional technology has led to greater options for patient management. However, future design, engineering, and implementation of systems will need to focus on a goal of broadening these applications.

Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice.

Beinart R, Nazarian S Circulation. 2013 Dec 24;128(25):2799-809.

Excellent paper about the basic principles of pontential harmful effect of electromagnetic field or interference (EMI) on implantable devices ( CIED). Physicians attending to patients with CIEDs must be aware of typical EMI sources and strategies to prevent malfunction of CIEDs.

Magnetic resonance imaging and implantable devices.

Nazarian S, Beinart R, Halperin HR. Circ Arrhythm Electrophysiol 2013 Apr;6(2):419-28.

A comprehensive rewiev concludes that familiarity with each device class and its potential for electromagnetic interaction is essential for cardiologists and electrophysiologists whose
patients may require MRI.