title: MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators.
abstract: This joint consensus paper of the German Roentgen Society and the German Cardiac Society provides physical and electrophysiological background information and specific recommendations for the procedural management of patients with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD) undergoing magnetic resonance (MR) imaging. The paper outlines the responsibilities of radiologists and cardiologists regarding patient education, indications, and monitoring with modification of MR sequences and PM/ICD reprogramming strategies being discussed in particular. The aim is to optimize patient safety and to improve legal clarity in order to facilitate the access of SM/ICD patients to MR imaging.Key Points:· Conventional PM and ICD systems are no longer an absolute but rather a relative contraindication for performing an MR examination. Procedural management includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific risks and "off label" use, extensive PM/ICD-related and MR-related safety precautions to reduce these risks to the greatest extent possible, as well as adequate monitoring techniques.. · MR conditional pacemaker and ICD systems have been tested and approved for MR examination under specific conditions ("in-label" use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety.. · The risk for an ICD patient during MR examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems. The indication for a MR examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/benefit ratio should be critically reviewed.. · This complex subject requires close collaboration between radiology and cardiology..Citation Format· Sommer T, Bauer W, Fischbach K et al. MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators. Fortschr Röntgenstr 2017; 189: 204 - 217.
authors.affiliation: Klinik für Diagnostische und Interventionelle Radiologie, DRK Krankenhaus Neuwied - Department of Diagnostic and Interventional Radiology, German Red Cross Hospital Neuwied, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Sommer
authors.affiliation: Med. Klinik und Poliklinik I Univ. Klinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz Univ. Würzburg - Department of Internal Medicine I, University Hospital Würzburg, Germany, Center for Heart Failure Research, University of Würzburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bauer
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg - Department of Radiology and Nuclearmedicine, University Hospital Magdeburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Fischbach
authors.affiliation: Klinik für Herz- und Kreislauferkrankungen, Deutsche Herzzentrum Muenchen, Muenchen, Deutschland- Department of Cardiology, German Heart Center Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.affiliation: Institut für Biomedizinische Technik, Universität und ETH Zürich - Institute for Biomedical Engineering, University and ETH Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Luechinger
authors.affiliation: Klinik für Kardiologie, Schwerpunkt Rhythmologie und Elektrophysiologie, Sana-Klinikum Remscheid, Remscheid - Department of Cardiology,Rhytmology and Electrophysiology, Sana-Clinics Remscheid, Remscheid, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Wiegand
authors.affiliation: Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen - Diagnostic and Interventional Radiology, University Hospital Göttingen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Lotz
authors.affiliation: Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH) - Department of Internal Medicine II (Cardiology, Angiology, Intensive Care) University Heart Center Luebeck, University Hospital, Schleswig-Holstein, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig - German Heart Center Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH) - Department of Internal Medicine II (Cardiology, Angiology, Intensive Care) University Heart Center Luebeck, University Hospital, Schleswig-Holstein, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Radiologische Klinik, Unversitätsklinikum Bonn - Department of Radiology, University Hospital Bonn, Germany.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.affiliation: Klinik für Kardiologie, Pneumologie und Angiologie, Universitaetsklinikum Duesseldorf, Duesseldorf -Department of Cardiology, Pneumolgy and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Hochfeld- und Hybride MR-Bildgebung, Universitätsklinikum Essen, Essen; Erwin L. Hahn Institut für MR-Bildgebung, Universität Duisburg-Essen, Essen - High Field and Hybrid MR Imaging, University Hospital Essen; Erwin L. Hahn Institute for MR Imaging, Germany.
authors.forename: Harald H
authors.initials: HH
authors.lastname: Quick
authors.affiliation: Experimental Clinical Research Center, Kardiologie, Charité Campus Buch, ECRC, Universitätsmedizin Berlin, Berlin, Deutschland, HELIOS Klinikum Berlin-Buch, Klinik für Kardiologie und Nephrologie, Deutschland - Experimental Clinical Research Center,Cardiology, Charité Campus Buch, University Medicine Berlin Germany, HELIOS Clinics Berlin-Buch, Department Cardiology and Nephrology, Berlin, Germany.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein - Department of Radiology and Nuclearmedicine, University Hospital Luebeck, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Barkhausen
authors.affiliation: Klinik für Innere Medizin/Kardiologie KMG-Kliniken Güstrow, Deutschland - Department of Internal Medicine/Kardiology, KMG Hospital Guestrow, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bänsch
mesh_terms: D002309:Cardiology / Q000592:standards; D000075202:Contraindications; D017147:Defibrillators, Implantable / Q000592:standards*; D005858:Germany; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D010138:Pacemaker, Artificial / Q000592:standards*; D010353:Patient Education as Topic / Q000592:standards*; D017410:Practice Guidelines as Topic