[angio]

"Cardiology's Biggest Lie: No MRI for Your Device Patient"
Melissa Walton-Shirley, MD Cardiologist, Cardiology Associates, Glasgow, Kentucky

Pooling their data with published papers, the German authors found that 1043 patients with devices (including ICDs) had undergone MRI safely. "No life-threatening complications have been observed," they concluded. In addition, "in just 11 cases (1%), electrical resetting of the device was necessary, and a significant increase in pacing threshold (>1.0 mV) was seen in 16 cases (1.5%)." While they acknowledge that the study conditions varied widely, including differences in localization, field strength of the scanner, device, sensors, etc, their review provides a good estimation of how frequently complications can be expected.

In March of 2011, Russo received approval from the CMS for payment for MRI scans if a facility agreed to participate in the MagnaSafe trial. Previously reported by heartwire , the trial was originally set to enroll 1500 participants and excluded pacer-dependent patients who have ICDs, abandoned leads, and abdominal implants. It also excluded those patients with any device with an FDA MRI-friendly label. According to Clinicaltrials.gov, there are 21 facilities in 14 states that are participating. The study is ongoing but not recruiting.

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другое мнение:

In fact, shortly after this, the author reports the reported rates of adverse events from the study, with 1.5% of participants seeing a post-MRI "significant increase in pacing threshold." One of the leading theories of the cause of the need of the pacer to send greater voltage to the heart in order to effectively pace it after an MRI exam is because of lead heating damaging or destroying cells in direct contact with the lead tips. This essentially creates an electrically-insulating barrier between the lead tip and the cardiac tissues, requiring the pulse generator to expend more energy to accomplish the job.

The American College of Radiology, in their 2013 Guidance Document on MR Safety Practices, offers the following list of potential risks associated with imaging pacing devices not specifically approved for use in MRI:

"Potential Complications: Unexpected programming changes, inhibition of pacemaker output, failure to pace, transient asynchronous pacing, rapid cardiac pacing, the induction of ventricular fibrillation, heating of the tissue adjacent to the pacing or ICD system and especially cardiac tissue near the lead tip, early battery depletion, and outright device failure requiring replacement may occur during MRI of patients with pacemakers or ICDs (18,29–31). Multiple deaths have been documented to occur under poorly and incompletely characterized circumstances when CIED patients underwent MRI (32–34). These deaths may have occurred as a result of pacemaker inhibition, failure to capture or device failure (resulting in prolonged asystole) and or rapid cardiac pacing or asynchronous pacing (resulting in the initiation of ventricular tachycardia or fibrillation)." -- [Ссылки доступны только зарегистрированным пользователям ]