title: Safety and imaging quality of MRI in pediatric and adult congenital heart disease patients with pacemakers.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is a standard of care in evaluating many disease processes. Given concerns about device damage or movement, programming changes, lead heating, inappropriate pacing, and image artifact, MRI is contraindicated in pacemaker patients. Despite this, studies have demonstrated safety and efficacy of MRI in adults with acquired heart disease and endocardial pacing leads. We sought to evaluate MRI use in congenital heart disease (CHD) patients with predominantly epicardial pacing leads.
  
  
  METHODS
  From July 2007 to October 2008, MRI (1.5 Tesla) was performed in 11 patients without alternative imaging modality who were not pacemaker dependent or possessing abandoned leads. Pacing was disabled during MRI. An electrophysiologist monitored electrocardiogram and hemodynamic parameters throughout each study. Device and lead function were evaluated before and after MRI, and at subsequent clinic visits.
  
  
  RESULTS
  Eleven MRIs (four cardiac, seven noncardiac) were performed in eight patients. Mean patient age was 16.5 +/- 9.2 years (range 1.7-24.5) with five patients under the age of 16 years. Diagnoses included structural CHD in six patients and long QT syndrome and congenital heart block in one each. There were three dual- and five single- (three atrial, two ventricular) chamber devices, two endocardial, and nine epicardial leads. No inappropriate pacing or significant change in generator or lead parameters was noted. All MRI studies were of diagnostic quality.
  
  
  CONCLUSIONS
  Diagnostic quality MRI can be performed safely in nonpacemaker-dependent CHD patients with predominantly epicardial leads. Further studies will define safe practice measures in this population, as well as in CHD patients with pacemaker dependency.
authors.affiliation: Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA. aaron.pulver@imail.org
authors.forename: Aaron F
authors.initials: AF
authors.lastname: Pulver
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: L Luann
authors.initials: LL
authors.lastname: Minich
authors.forename: Jason T
authors.initials: JT
authors.lastname: Su
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Saarel
authors.forename: Patricia
authors.initials: P
authors.lastname: Whitaker
authors.forename: Susan P
authors.initials: SP
authors.lastname: Etheridge