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Cardiac magnetic resonance imaging in patients with a nonconditional cardiac implantable device: Good-quality images besides safety are essential

Published:November 20, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.11.022
      Indications for use of magnetic resonance imaging (MRI) have increased exponentially in the last 2 decades because of its unique diagnostic capability for soft tissue imaging, and it has become the main tool for evaluating disorders of the central nervous, musculoskeletal, and cardiovascular systems, as well as for oncologic conditions. This rise in the number of indications has coincided with an increase in the number of cardiac implanted electronic devices (CIEDs). In this scenario, the safety of MRI performed in patients with a previously implanted CIED is a crucial issue. Traditionally, MRI has been considered hazardous if performed in a patient with a CIED because of potential life-threatening interactions between the MRI scanner and the pacemaker (PM) or implantable cardioverter–defibrillator (ICD). The mechanisms underlying the lack of safety are related to mechanical forces (possible movement of devices due to interiorly located metal); induction phenomena (electrical currents that could initiate arrhythmias or thermal damage at the level of myocardium, leading a scar); lead tip heating; loss of capture, oversensing, and inhibition of PM; asynchronous pacing and induction of arrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF); and inappropriate ICD shock due to rapidly changing magnetic gradients registered as arrhythmias. To prevent these risks, several manufacturers developed “MRI-conditional” PMs and ICDs, which have improved lead design, modified hardware design with an automated switched on, and fewer ferromagnetic components.
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