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
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
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DOI：
10.1161/circulationaha.105.597013
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发表时间：
2006-09-19
期刊：
影响因子：
37.8
通讯作者：
Schild, Hans
中科院分区：
文献类型：
--
作者：
Sommer, Torsten;Naehle, Claas P.;Schild, Hans
背景-本研究的目的是评估在使用心脏起搏器的非起搏器依赖性患者中安全进行胸外磁共振成像（MRI）的策略。方法和结果-纳入标准是存在心脏起搏器并且临床迫切需要进行 MRI 检查。依赖起搏器的患者和需要胸部区域检查的患者被排除在外。研究组由 82 名起搏器患者组成，他们总共接受了 115 次 1.5T MRI 检查。为了最大限度地减少与射频相关的铅加热，比吸收率限制为 1.5 W/kg。所有起搏器在 MRI 之前都进行了重新编程：如果心率 < 60 bpm，则编程异步模式以避免磁共振 (MR) 引起的抑制；如果心率 > 60 bpm，则使用仅感知模式以避免 MR 引起的竞争性起搏和潜在的致心律失常。通过心电图和脉搏血氧饱和度监测患者。所有起搏器均在 MRI 检查前后和 3 个月后接受检查，包括测量起搏捕获阈值 (PCT) 和血清肌钙蛋白 I 水平。所有 MR 检查均安全完成。没有观察到起搏器输出的抑制或心律失常的诱导。从 MRI 前到 MRI 后，PCT 显着增加 (P = 0.017)。 195 条线索中的 2 条仅在随访时才检测到 PCT 增加。在 114 项检查中，有 4 项检查结果显示 MRI 后肌钙蛋白从正常基线值升高至高于正常值，其中 1 例（MRI 前肌钙蛋白 0.02 ng/mL，MRI 后 0.16 ng/mL）这种升高与 PCT 显着升高相关。 MR 和起搏器相关的预防措施。
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.