title: Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ.
abstract: Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.
authors.affiliation: Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, London, UK.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quarta
authors.forename: Diana R
authors.initials: DR
authors.lastname: Holdright
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Plant
authors.forename: Allan
authors.initials: A
authors.lastname: Harkness
authors.forename: Derek
authors.initials: D
authors.lastname: Hausenloy
authors.forename: Harpreet
authors.initials: H
authors.lastname: Hyare
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
mesh_terms: D016477:Artifacts; D002304:Cardiac Pacing, Artificial; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004489:Edema, Cardiac / Q000175:diagnosis / Q000209:etiology; D004867:Equipment Design; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology; D007165:Immunosuppression Therapy; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy