title: Clinical value of cardiovascular magnetic resonance in patients with MR-conditional pacemakers.
abstract: OBJECTIVE
  Magnetic resonance (MR) conditional pacemakers are increasingly implanted into patients who may need cardiovascular MR (CMR) subsequent to device implantation. We assessed the added value of CMR for diagnosis and management in this population.
  
  
  RESULTS
  CMR and pacing data from consecutive patients with MR conditional pacemakers were retrospectively reviewed. Images were acquired at 1.5 T (Siemens Magnetom Avanto). The indication for CMR and any resulting change in management was recorded. The quality of CMR was rated by an observer blinded to clinical details, and data on pacemaker and lead parameters were collected pre- and post-CMR. Seventy-two CMR scans on 69 patients performed between 2011 and 2015 were assessed. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Steady-state free precession (SSFP) cine imaging resulted in a greater frequency of non-diagnostic imaging (22 vs. 1%, P < 0.01) compared with gradient echo sequences (GRE). Right-sided pacemakers were associated with less artefact than left-sided pacemakers. Late gadolinium enhancement imaging was performed in 59 scans with only 2% of segments rated of non-diagnostic quality. The CMR data resulted in a new diagnosis in 27 (38%) of examinations; clinical management was changed in a further 18 (25%).
  
  
  CONCLUSIONS
  CMR in patients with MR conditional pacemakers provided diagnostic or management-changing information in the majority (63%) of our cohort. The use of gradient echo cine sequences can reduce rates of non-diagnostic imaging. Right-sided device implantation may be considered in patients likely to require CMR examination.
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK c.raphael@rbht.nhs.uk claire.raphael@gmail.com.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Raphael
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vassiliou
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alpendurada
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Raad H
authors.initials: RH
authors.lastname: Mohiaddin
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: CMR; PPM; cardiovascular magnetic resonance; conditional; pacemaker