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עמוד בית
Tue, 18.06.24

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July 2010
O. Halshtok, O. Goitein, R. Abu Sham'a, H. Granit, M. Glikson and E. Konen
Background: Until recently, cardiac pacemakers and implantable cardioverter defibrillators were considered an absolute contraindication for magnetic resonance imaging. Given the significant increase in implanting such devices, these contraindications will preclude MRI scanning in a large patient population. Several recent reports have addressed the safety and feasibility of MRI in the presence of cardiac implantable devices.

Objectives: To summarize our experience with MRI scanning in the presence of pacemakers and implantable cardioverter defibrillators.

Methods: Eighteen patients (15 males and 3 females, median 59) were scanned using a 1.5 T MRI scanner. A clinical discussion was held to verify the absolute medical necessity of the study before performing the scan. Scan supervision included device interrogation and programming beforehand, patient monitoring during, and device interrogation and reprogramming after the scan. Full resuscitation equipment was available outside the MRI suite.

Results: Thirty-four scans were performed, and all but one were of diagnostic quality. Anatomic regions included the brain (N=26), cervical spine (N=2), lumbar spine (N=1), cardiac (N=2), abdomen (N=1), abdomen and pelvis (N=1) and pelvis (N=1). None of the patients reported any side effects and no life-threatening events occurred during or following the scans. Five cases of device spontaneous reversion to backup mode were recorded (four in the same patient). Device replacement was not required in any patient.

Conclusions: In this small cohort of patients MRI scanning in the presence of cardiac implantable devices was safe. MRI in these patients is feasible although not recommended for routine scans. Scans should be considered on a case-to-case basis and performed in a dedicated specialized setup.

 

October 2004
Y. Levy, O. Shovman, C. Granit, D. Luria, O. Gurevitz, D. Bar-Lev, M. Eldar, Y. Shoenfeld and M. Glikson

Background: The appearance of pericarditis following insertion of a permanent pacemaker is not widely acknowledged in the literature.

Objectives: To describe our experience with pericarditis following 395 permanent pacemaker implantations over 2 years.

Methods: We retrospectively reviewed the medical records of 395 consecutive patients in whom new pacing systems or pacemaker leads had been implanted over a 2 year period. We searched the records for pericarditis that developed within 1 month after pacemaker implantation according to the ICD-9 code. The incidence, clinical picture, response to treatment and relationship to lead design and location were studied.

Results: Eight cases (2%) of pericarditis following implantation were detected. Clinical manifestations in all patients were similar to those of post-pericardiotomy syndrome and included chest pain (n=7), friction rub (n=1), fever (n=2), fatigue (n=2), pleural effusion (n=2), new atrial fibrillation (n=2), elevated erythrocyte sedimentation rate (n=4) and echcardiographic evidence of pericardial effusion (n=8). All affected patients had undergone active fixation (screw-in) lead implantation in the atrial position. The incidence of pericarditis with screw-in atrial leads was 3% compared to 0% in other cases (P < 0.05).

Conclusions: Pericarditis is not uncommon following pacemaker implantation with active fixation atrial leads. Special attention should be paid to identifying pericardial complications following pacemaker implantation, especially when anticoagulant therapy is resumed or initiated. The use of passive fixation leads is likely to reduce the incidence of pericarditis but this issue should be further investigated.

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