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(Circulation. 2006;114:1285-1292.)
© 2006 American Heart Association, Inc.

Imaging

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

Torsten Sommer, MD^*; Claas P. Naehle, MD^*; Alexander Yang, MD; Volkert Zeijlemaker, PhD; Matthias Hackenbroch, MD; Alexandra Schmiedel, MD; Carsten Meyer, MD; Katharina Strach, MD; Dirk Skowasch, MD; Christian Vahlhaus, MD; Harold Litt, MD, PhD; Hans Schild, MD

From the Departments of Radiology (T.S., C.P.N., M.H., A.S., C.M., K.S., H.S.) and Cardiology (A.Y., D.S.), University of Bonn, Bonn, Germany; Medtronic Bakken Research Center (V.Z.), Maastricht, Netherlands; Department of Cardiology and Angiology (C.V.), Hospital of the University of Muenster, Muenster, Germany; and Department of Radiology of the University of Pennsylvania School of Medicine (H.L.), Philadelphia, Pa.

Correspondence to Torsten Sommer, MD, Associate Professor of Radiology, Chief, Cardiovascular Imaging Section, University of Bonn, Department of Radiology, Sigmund Freud Straße 25, 53127 Bonn, Germany. E-mail t.sommer{at}uni-bonn.de

Received October 24, 2005; revision received June 19, 2006; accepted June 23, 2006.

Background— The purpose of the present study was to evaluate a strategy for safe performance of extrathoracic magnetic resonance imaging (MRI) in non–pacemaker-dependent patients with cardiac pacemakers.

Methods and Results— Inclusion criteria were presence of a cardiac pacemaker and urgent clinical need for an MRI examination. Pacemaker-dependent patients and those requiring examinations of the thoracic region were excluded. The study group consisted of 82 pacemaker patients who underwent a total of 115 MRI examinations at 1.5T. To minimize radiofrequency-related lead heating, the specific absorption rate was limited to 1.5 W/kg. All pacemakers were reprogrammed before MRI: If heart rate was <60 bpm, the asynchronous mode was programmed to avoid magnetic resonance (MR)–induced inhibition; if heart rate was >60 bpm, sense-only mode was used to avoid MR-induced competitive pacing and potential proarrhythmia. Patients were monitored with ECG and pulse oximetry. All pacemakers were interrogated immediately before and after the MRI examination and after 3 months, including measurement of pacing capture threshold (PCT) and serum troponin I levels. All MR examinations were completed safely. Inhibition of pacemaker output or induction of arrhythmias was not observed. PCT increased significantly from pre- to post-MRI (P=0.017). In 2 of 195 leads, an increase in PCT was only detected at follow-up. In 4 of 114 examinations, troponin increased from a normal baseline value to above normal after MRI, and in 1 case (troponin pre-MRI 0.02 ng/mL, post-MRI 0.16 ng/mL), this increase was associated with a significant increase in PCT.

Conclusions— Extrathoracic MRI of non–pacemaker-dependent patients can be performed with an acceptable risk-benefit ratio under controlled conditions and by taking both MR- and pacemaker-related precautions.

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