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Empfehlungen zu kardialen MRT-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren [Recommendations for cardiac magnetic resonance imaging in patients with cardiac pacemakers andimplantable cardioverter defibrillators]

Item Type:Article
Title:Empfehlungen zu kardialen MRT-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren [Recommendations for cardiac magnetic resonance imaging in patients with cardiac pacemakers andimplantable cardioverter defibrillators]
Creators Name:von Knobelsdorff-Brenkenhoff, F. and Bauer, W.R. and Deneke, T. and Fleck, E. and Rolf, A. and Schulz-Menger, J. and Sommer, P. and Tillmanns, C. and Eitel, I.
Abstract:These recommendations by the German Society for Cardiology (DGK) summarize specific characteristics of cardiac magnetic resonance imaging (MRI) in subjects with a cardiac pacemaker (PM) or implantable cardioverter defibrillator (ICD). They represent a supplement/update of the comprehensive consensus paper of the DGK and the German Roentgen Society on MRI examinations in general in patients with PM and ICD published in 2017. With a focus on cardiac MRI, physical and electrophysiological explanations are given, which are helpful for the understanding and handling by experienced users. Detailed recommendations regarding indications, patient selection, device programming, patient monitoring and MRI sequence modification are provided. The aim of this article is to grant subjects with active cardiac implants access to cardiac MRI examinations after careful consideration of the clinical need and potential limitations regarding patient safety and image quality. The essentials of this recommendation paper are: 1) as is common sense for MRI examinations in general, conventional (i. e. not MRI conditional) PM and ICD are no longer regarded as absolute contraindications for performing cardiac MRI but as relative contraindications. 2) Cardiac MRI in patients with PM or ICD is, however, associated with a particular risk, as the device is within the imaging field and interactions between the device, MRI and tissue may be aggravated. In addition, the myocardium of the patient under investigation may be vulnerable and therefore possibly prone to any confounding effects. 3) Apart from safety concerns, image quality can be unfavorably influenced by PM or ICD systems, so that adjusted MRI pulse sequences can be necessary. 4) The individual risk-benefit analysis, a comprehensive informed consent about specific risks, targeted device and MRI-related safety measures, as well as adequate monitoring techniques during the MRI examination are highly important to reduce such risks when planning a cardiac MRI in a patient with a PM or ICD. This complexity makes the presence of experienced physicians trained in cardiac MRI and PM/ICD treatment mandatory. 5) Even if some PM and ICD are approved as being safe for cardiac MRI (MRI conditional), precautionary and monitoring measures are widely the same as for conventional PM and ICD systems. For patient safety, exact knowledge and consideration of the specific terms and conditions of use of the respective device are obligatory.
Keywords:Magnetic Resonance Imaging, Pacemaker, Implantable Cardioverter Defibrillator (ICD), Artifacts, Safety
Source:Kardiologe
ISSN:1864-9718
Publisher:Springer (Germany)
Date:2019
Official Publication:https://doi.org/10.1007/s12181-019-0301-x

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