© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
REVIEW
Do we need pacemakers resistant to magnetic resonance imaging?
aDepartment of Legal Medicine, University Hospital Giessen, Germany; bDepartment of Diagnostic Radiology, University Hospital Giessen, Germany; cDepartment of General and Thoracic Surgery, University Hospital Giessen, Germany
AIMS: Manufacturers of pacemakers (PM) and of magnetic resonance imaging (MRI) devices state that MRI scanning of PM wearers is contraindicated. This paper tries to summarise which effects can interfere with PM, what can be hazardous, and how treatment of PM in MRI can be modified to guarantee compatibility.
MATERIAL AND METHODS: All PM tested were from deceased patients. Reed contact thresholds and reactions were investigated in low magnetostatic fields and compared with those in strong magnetostatic fields. Influence of gradient fields on PM and heating due to radiofrequency (RF) pulses were estimated. Thirty Legal Medicine Departments were questioned whether deaths of PM patients during MRI are known.
RESULTS: Reed contacts are influenced above 0.7 mT. In MRI fields only 28% of the PM in magnet mode remained so in all orientations. Of synchronous PM, 76% remained synchronous in all orientations. Gradient fields can influence sensing but cannot stimulate. Power density and temperature rise produced by RF fall rapidly with distance. Our question revealed six deaths. All suffered from sick-sinus-syndrome and all were not PM dependent. In three cases ventricular fibrillation was proven as the cause of death.
DISCUSSION: Asynchronous pacing due to magnetostatic and gradient fields may be problematic in patients with spontaneous rhythm. To avoid them, PM triggered MRI scan restricted to refractory period is proposed. Neither inhibition of PM nor heating of the electrode poses real risks. So far, we have examined eight patients 12 times in MRI triggered mode without problems.
Key Words: magnetic resonance imaging, pacemaker, interference, heating of electrodes, death during MRI
*Corresponding author. Department of Legal Medicine, University Hospital, Frankfurter Str. 58, 35392 Giessen, Germany. Tel.: +49 641 99 41390; fax: +49 641 99 41399. E-mail address: werner.irnich{at}technik.med.uni-giessen.de (W. Irnich).
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Roguin, J. Schwitter, C. Vahlhaus, M. Lombardi, J. Brugada, P. Vardas, A. Auricchio, S. Priori, and T. Sommer Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices Europace, March 1, 2008; 10(3): 336 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. N. Levine, A. S. Gomes, A. E. Arai, D. A. Bluemke, S. D. Flamm, E. Kanal, W. J. Manning, E. T. Martin, J. M. Smith, N. Wilke, et al. Safety of Magnetic Resonance Imaging in Patients With Cardiovascular Devices: An American Heart Association Scientific Statement From the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: Endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance Circulation, December 11, 2007; 116(24): 2878 - 2891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Kanal, A. J. Barkovich, C. Bell, J. P. Borgstede, W. G. Bradley Jr., J. W. Froelich, T. Gilk, J. R. Gimbel, J. Gosbee, E. Kuhni-Kaminski, et al. ACR Guidance Document for Safe MR Practices: 2007 Am. J. Roentgenol., June 1, 2007; 188(6): 1447 - 1474. [Full Text] [PDF]
|
|
|
|
|
|
T. Sommer, C. P. Naehle, A. Yang, V. Zeijlemaker, M. Hackenbroch, A. Schmiedel, C. Meyer, K. Strach, D. Skowasch, C. Vahlhaus, et al. Strategy for Safe Performance of Extrathoracic Magnetic Resonance Imaging at 1.5 Tesla in the Presence of Cardiac Pacemakers in Non-Pacemaker-Dependent Patients: A Prospective Study With 115 Examinations Circulation, September 19, 2006; 114(12): 1285 - 1292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nazarian, A. Roguin, M. M. Zviman, A. C. Lardo, T. L. Dickfeld, H. Calkins, R. G. Weiss, R. D. Berger, D. A. Bluemke, and H. R. Halperin Clinical Utility and Safety of a Protocol for Noncardiac and Cardiac Magnetic Resonance Imaging of Patients With Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla Circulation, September 19, 2006; 114(12): 1277 - 1284. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Naehle, H. Litt, T. Lewalter, and T. Sommer Do we need pacemakers resistant to magnetic resonance imaging? Europace, January 1, 2006; 8(5): 388 - 388. [Full Text] [PDF]
|
|
|
|
|
|
W. E. Irnich Reply to the letter of Naehle et al. Europace, January 1, 2006; 8(5): 389 - 389. [Full Text] [PDF]
|
|
|
|
|
|
W. E. Irnich Reply to the letter of Luechinger et al. Europace, January 1, 2006; 8(5): 390 - 391. [Full Text] [PDF]
|
|
|
|
|
|
C. Vahlhaus Pacemakers (PM) and MRI. Europace, January 1, 2006; 8(5): 391 - 391. [Full Text] [PDF]
|
|
|
|
|
|
R. Luechinger, V. A. Zeijlemaker, P. Boesiger, and F. Duru Potential harmful effects of magnetic resonance imaging in pacemaker patients should not be underestimated. Europace, January 1, 2006; 8(5): 389 - 390. [Full Text] [PDF]
|
|
|
|
|
|
W. Irnich Reply to the letter of Vahlhaus. Europace, January 1, 2006; 8(5): 391 - 392. [Full Text] [PDF]
|
|