J. Rod Gimbel

ACR Guidance Document for Safe MR Practices: 2007

E. Kanal is a consultant for, is a member of the speakers bureau of, and provides research support for Bracco Diagnostics and GE Healthcare; is a member of the speakers bureau of and provides research support for Siemens Medical Solutions; and provides research support for Berlex and Medtronic. T. Gilk is a consultant for Mednovus, Inc. J. R. Gimbel provides research support for St. Jude Medical, Medtronic, and Biotronik. J. Nyenhuis is a consultant for and provides research support to Medtronics. J. Weinreb is a consultant and member of the speakers bureau for GE Healthcare.

ACR guidance document on MR safe practices: 2013

Because there are many potential risks in the MR environment and reports of adverse incidents involving patients, equipment and personnel, the need for a guidance document on MR safe practices emerged. Initially published in 2002, the ACR MR Safe Practices Guidelines established de facto industry standards for safe and responsible practices in clinical and research MR environments. As the MR industry changes the document is reviewed, modified and updated. The most recent version will reflect these changes. J. Magn. Reson. Imaging 2013;37:501–530.

Outcome of Magnetic Resonance Imaging (MRI) in Selected Patients with Implantable Cardioverter Defibrillators (ICDs)

Objective: To determine if simple strategies used to safely scan pacemaker patients could be applied to implantable cardioverter defibrillator (ICD), patients undergoing MRI allowing ICD patients to undergo MRI as well.

Strategies for the Safe Magnetic Resonance Imaging of Pacemaker-Dependent Patients

Objective: To determine if strategies used to safely scan nonpacemaker‐dependent patients could be applied to facilitate safe MRI of pacemaker‐dependent patients.

Randomized trial of pacemaker and lead system for safe scanning at 1.5 Tesla.

BACKGROUND Magnetic resonance imaging (MRI) of pacemakers is a relative contraindication because of the risks to the patient from potentially hazardous interactions between the MRI and the pacemaker system. Chest scans (ie, cardiac magnetic resonance scans) are of particular importance and higher risk. The previously Food and Drug Administration-approved magnetic resonance conditional system includes positioning restrictions, limiting the powerful utility of MRI. OBJECTIVE To confirm the safety and effectiveness of a pacemaker system designed for safe whole body MRI without MRI scan positioning restrictions. METHODS Primary eligibility criteria included standard dual-chamber pacing indications. Patients (n = 263) were randomized in a 2:1 ratio to undergo 16 chest and head scans at 1.5 T between 9 and 12 weeks postimplant (n = 177) or to not undergo MRI (n = 86) post-implant. Evaluation of the pacemaker system occurred immediately before, during (monitoring), and after MRI, 1-week post-MRI, and 1-month post-MRI, and similarly for controls. Primary end points measured the MRI-related complication-free rate for safety and compared pacing capture threshold between MRI and control subjects for effectiveness. RESULTS There were no MRI-related complications during or after MRI in subjects undergoing MRI (n = 148). Differences in pacing capture threshold values from pre-MRI to 1-month post-MRI were minimal and similar between the MRI and control groups. CONCLUSIONS This randomized trial demonstrates that the Advisa MRI pulse generator and CapSureFix MRI 5086MRI lead system is safe and effective in the 1.5 T MRI environment without positioning restrictions for MRI scans or limitations of body parts scanned.

Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 Tesla

Background: A relaxation of the prohibition of scanning cardiac rhythm device patients is underway, largely because of the growing experience of safe scanning events at 1.5T. Magnetic resonance imaging (MRI) at 3T is becoming more common and may pose a different risk profile and outcome of MRI of cardiac device patients.

2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices

Julia H. Indik, MD, PhD, FHRS, FACC, FAHA (Chair), J. Rod Gimbel, MD (Vice-Chair), Haruhiko Abe, MD,* Ricardo Alkmim-Teixeira, MD, PhD, Ulrika Birgersdotter-Green, MD, FHRS, Geoffrey D. Clarke, PhD, FACR, FAAPM,6,x Timm-Michael L. Dickfeld, MD, PhD, Jerry W. Froelich, MD, FACR,8,{ Jonathan Grant, MD, David L. Hayes, MD, FHRS, Hein Heidbuchel, MD, PhD, FESC,** Salim F. Idriss, MD, PhD, FHRS, FACC, Emanuel Kanal, MD, FACR, FISMRM, MRMD, Rachel Lampert, MD, FHRS, Christian E. Machado, MD, FHRS, CCDS, John M. Mandrola, MD, Saman Nazarian, MD, PhD, FHRS, Kristen K. Patton, MD, Marc A. Rozner, PhD, MD, CCDS, Robert J. Russo, MD, PhD, FACC, Win-Kuang Shen, MD, FHRS,21,xx Jerold S. Shinbane, MD, FHRS, Wee Siong Teo, MBBS (NUS), FRCP (Edin), FHRS,23,{{ William Uribe, MD, FHRS, Atul Verma, MD, FRCPC, FHRS, Bruce L. Wilkoff, MD, FHRS, CCDS, Pamela K. Woodard, MD, FACR, FAHA***

Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy.

Left atrium (LA) low voltage area (LVA) on 3‐D electroanatomic bipolar voltage mapping (EAVM), as a surrogate for scar, is associated with poor AF ablation outcome. We evaluated the long‐term outcome of an LVA‐guided atrial fibrillation (AF) substrate modification strategy as an adjunct to pulmonary vein isolation (PVI).

Correlation of Left Atrial Voltage Distribution Between Sinus Rhythm and Atrial Fibrillation: Identifying Structural Remodeling by 3-D Electroanatomic Mapping Irrespective of the Rhythm.

Left atrial (LA) electroanatomical voltage mapping (EAVM) correlates with scar on LGE‐MRI and has been used to guide ablation of low voltage area (LVA) in sinus rhythm (SR). We compared EAVM in SR and AF in a cohort of AF patients, and in SR between patients with AF and without AF or structural heart disease (control).

Unexpected pacing inhibition upon exposure to the 3T static magnetic field prior to imaging acquisition: What is the mechanism?

t u s w Case summary A 62-year-old man with an implantable cardioverterdefibrillator (ICD) and a history of lung cancer developed severe headaches. During performance of cranial 3T (Signa Excite-HD, General Electric, Waukesha, WI, USA) magnetic resonance imaging (MRI), the patient was monitored with both ECG and pulse oximetry. The patient’s hemodynamically stable underlying rhythm was sinus at 40 to 45 bpm with a narrow QRS and normal PR interval (Figure 1A). The pre-MRI programming strategy chosen for the patient’s St. Jude Medical (Sylmar, CA, USA) Atlas II DR V-238 (A-lead: St. Jude Medical 1388TC-52 cm; V-lead: Medtronic [Mounds View, MN, USA] 6947-58 cm) was all tachycardia therapies “off”, AAI pacing at 70 ppm, and nominal sensitivities. The patient’s paced rhythm through the programmer just prior to the patient being placed on the table in the MRI suite is shown in Figure 1B. After pre-MRI programming of the ICD was completed, the patient was placed on the MRI table, and AAI pacing at 70 ppm was noted (Figure 1C). Upon moving the patient into the bore of the magnet head first, pacing was inhibited prior to the application of any radiofreuency (RF) or gradient magnetic fields and remained nhibited after table movement ceased (Figure 1D). Beause the patient’s rhythm remained stable, the decision as made to continue the scan without interruption. Pacng remained inhibited during and after RF and gradient eld application.