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How to perform magnetic resonance imaging on patients with implantable cardiac arrhythmia devices

Published:October 24, 2008DOI:https://doi.org/10.1016/j.hrthm.2008.10.021
      Magnetic resonance imaging (MRI) offers unrivaled soft tissue resolution and multiplanar imaging capabilities. Cardiac MRI is capable of accurate characterization of cardiac function and is uniquely capable of identifying scar fibrosis and fat deposition, thus making it an ideal imaging modality for the evaluation of patients presenting with arrhythmia. In addition, the absence of x-ray radiation makes MRI suitable for follow-up of chronic disease and for imaging in young patients and women of childbearing age. Due to the ever expanding indications for implantation of permanent pacemakers and implantable cardioverter-defibrillators (ICDs), advancing severity of disease and age of the population, and advances in device technology, the number of patients with implantable cardiac devices will continue to increase. It has been estimated that each patient with a pacemaker or ICD has a 50% to 75% likelihood of having a clinical indication for MRI over the lifetime of their device. When performed with appropriate supervision and following a protocol for safety, many studies over the past 10 years have reported the safety of MRI with selected devices. However, catastrophic complications with older devices have been reported. Familiarity with each device class and its potential for electromagnetic interaction is essential for electrophysiologists whose patients may require MRI.

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