ICDS
Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices
1 Department of Cardiology, Rambam Medical Center, B. Rappaport-Faculty of Medicine, Technion-Israel Institute of Technology, Bat Galim, PO Box 9602, Haifa 31096, Israel; 2 Division of Cardiology, Department of International Medicine (DIM), University Hospital Zürich, Zürich, Switzerland; 3 Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany; 4 MRI Laboratory, C.N.R., Clinical Physiology Institute, Pisa, Italy; 5 Arrhythmia Section, Cardiovascular Institute Hospital Clinic, University of Barcelona, Barcelona, Spain; 6 Cardiology Department, Heraklion University Hospital, Heraklion Crete, Greece; 7 Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland; 8 Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, University of Pavia, Pavia, Italy; 9 Cardiovascular Imaging Section, Department of Radiology, University of Bonn, Bonn, Germany
Magnetic resonance (MR) imaging has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter-defibrillators (ICDs), however, was historically considered a contraindication to MR imaging. We summarize the potential hazards of the device–MR environment interaction, and present updated information regarding in vitro and in vivo experiments suggesting that certain pacemaker and ICD systems may indeed be MR-safe. Recent reports on several hundred patients with implantable pacemakers and ICDs who underwent MR scan safely indicate that, under certain conditions, individuals with these implanted systems may benefit from MR imaging. We believe that, on a case-by-case basis, the diagnostic benefit from MR imaging outweighs the presumed risks for some pacemaker and ICD patients. Thus for some patients, the risks presented by MR imaging under specific, characterized scanning and monitoring conditions may be acceptable given the diagnostic benefit of this powerful imaging modality. This may have major clinical implications on current imaging practice. A strategy for the performance of MR imaging in these individuals is proposed.
Key Words: Imaging, MR imaging, Safety, Pacemaker, ICD
* Corresponding author. Tel: +972 4 854 2181; Fax: +972 4 854 3451. E-mail address: aroguin{at}technion.ac.il
A Position Paper from European Heart Rhythm Association and Working Group on Cardiovascular Magnetic Resonance of the European Society of Cardiology (EuroCMR).
Manuscript submitted 24 December 2007. Accepted after revision 7 January 2008.