Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: in vitro and in vivo assessment of safety and function at 1.5 T.
BACKGROUND
MRI has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter/defibrillators (ICDs), however, is historically considered a contraindication to MRI. These devices are now smaller, with less magnetic material and improved electromagnetic interference protection. Our aim was to determine whether these modern systems can be used in an MR environment.


RESULTS
We tested in vitro and in vivo lead heating, device function, force acting on the device, and image distortion at 1.5 T. Clinical MR protocols and in vivo measurements yielded temperature changes <0.5 degrees C. Older (manufactured before 2000) ICDs were damaged by the MR scans. Newer ICD systems and most pacemakers, however, were not. The maximal force acting on newer devices was <100 g. Modern (manufactured after 2000) ICD systems were implanted in dogs (n=18), and after 4 weeks, 3- to 4-hour MR scans were performed (n=15). No device dysfunction occurred. The images were of high quality with distortion dependent on the scan sequence and plane. Pacing threshold and intracardiac electrogram amplitude were unchanged over the 8 weeks, except in 1 animal that, after MRI, had a transient (<12 hours) capture failure. Pathological data of the scanned animals revealed very limited necrosis or fibrosis at the tip of the lead area, which was not different from controls (n=3) not subjected to MRI.


CONCLUSIONS
These data suggest that certain modern pacemaker and ICD systems may indeed be MRI safe. This may have major clinical implications for current imaging practices.
Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
Ariel
A
Roguin
Menekhem M
MM
Zviman
Glenn R
GR
Meininger
E Rene
ER
Rodrigues
Timm M
TM
Dickfeld
David A
DA
Bluemke
Albert
A
Lardo
Ronald D
RD
Berger
Hugh
H
Calkins
Henry R
HR
Halperin
D000818:Animals; D000075202:Contraindications; D017147:Defibrillators, Implantable; D004285:Dogs; D055590:Electromagnetic Phenomena; D004867:Equipment Design; D004869:Equipment Safety; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010138:Pacemaker, Artificial; D013314:Stress, Mechanical; D013696:Temperature