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J Am Coll Cardiol, 2004; 43:1315-1324, doi:10.1016/j.jacc.2003.12.016
© 2004 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla

Edward T. Martin, MS, MD, FACC*{dagger},*, James A. Coman, MD, FACC*{dagger}, Frank G. Shellock, PhD{ddagger}, Christopher C. Pulling, MS§, Robert Fair, ARRT(R) (MR)* and Kim Jenkins, ARRT(R) (MR)*

* Oklahoma Heart Institute, Tulsa, Oklahoma, USA
{dagger} University of Oklahoma, Tulsa, Oklahoma, USA
{ddagger} University of Southern California, Keck School of Medicine and Institute of Magnetic Resonance Safety, Education, and Research, Los Angeles, California, USA
§ Integra CTS, Minneapolis, Minnesota, USA

* Reprint requests and correspondence: Dr. Edward T. Martin, Oklahoma Heart Institute, 9228 South Mingo Road, Tulsa, Oklahoma 74133, USA.
martin{at}oklahomaheart.com

OBJECTIVES: The study was done to determine whether patients with pacemakers could safely undergo magnetic resonance imaging (MRI) at 1.5-Tesla (T).

BACKGROUND: Because of theoretical risks, it is an absolute contraindication for a patient with a pacemaker to undergo MRI. However, there are times when an MRI is needed to provide valuable clinical information.

METHODS: Fifty-four patients underwent a total of 62 MRI examinations at 1.5-T. The type of MRI examination was not limited and included cardiac, vascular, and general MRI studies using various whole-body averaged specific absorption rate (SAR) of radiofrequency power. Restrictions were not placed on the type of pacemaker present in the patient. All pacemakers were interrogated immediately before and after MRI scanning, and patients were continuously monitored. Before and after MRI, interrogation was done, and pacing and sensing thresholds, as well as lead impedances, were all measured.

RESULTS: A total of 107 leads and 61 pulse generators were evaluated. No adverse events occurred. Forty (37%) of the leads underwent changes, whereas 10 (9.4%) leads underwent a significant change. Only 2 of the 107 (1.9%) leads required a change in programmed output. Threshold changes were unrelated to cardiac chamber, anatomical location, peak SAR, and time from lead implant to the MRI examination. Electrocardiographic changes and patient symptoms were minor and did not require cessation of MRI.

CONCLUSIONS: Safety was demonstrated in this series of patients with pacemakers at 1.5-T.

Abbreviations and Acronyms
  ACLS = advanced cardiac life support
  ECG = electrocardiographic/electrocardiography
  MR = magnetic resonance
  MRA = magnetic resonance angiography
  MRI = magnetic resonance imaging
  RF = radiofrequency
  SAR = specific absorption rate




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