Abstract
BackgroundThere are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging. The aim of this prospective, single-center, observational study was to evaluate artefacts on cardiovascular magnetic resonance (CMR) images in patients with LCP.MethodsFifteen patients with Micra™ LCP, implanted at least 6 weeks prior to CMR scan, were enrolled and underwent either 1.5 Tesla or 3 Tesla CMR imaging. Artefacts were categorized into grade 1 (excellent image quality), grade 2 (good), grade 3 (poor) and grade 4 (non-diagnostic) for each myocardial segment. One patient was excluded because of an incomplete CMR investigation due to claustrophobia.ResultsLCP caused an arc-shaped artefact (0.99 ± 0.16 cm2) at the right ventricular (RV) apex. Of 224 analyzed myocardial segments of the left ventricle (LV) 158 (70.5%) were affected by grade 1, 27 (12.1%) by grade 2, 17 (7.6%) by grade 3 and 22 (9.8%) by grade 4 artefacts. The artefact burden of grade 3 and 4 artefacts was significantly higher in the 3 Tesla group (3 Tesla vs 1.5 Tesla: 3.7 ± 1.6 vs 1.9 ± 1.4 myocardial segments per patient, p = 0.03). A high artefact burden was particularly observed in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV and in the mid and apical segments of the RV. Quantification of LV function and assessment of valves were feasible in all patients. We did not observe any clinical or device-related adverse events.ConclusionCMR imaging in patients with LCP is feasible with excellent to good image quality in the majority of LV segments. The artefact burden is comparable small allowing an accurate evaluation of LV function, cardiac structures and valves. However, artefacts in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV due to the LCP may impair or even exclude diagnostic evaluation of these segments. Artefacts on CMR images may be reduced by the use of 1.5 Tesla CMR scanners.
Highlights
There are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging
The artefact burden is comparable small allowing an accurate evaluation of left ventricle (LV) function, cardiac structures and valves
Artefacts on cardiovascular magnetic resonance (CMR) images may be reduced by the use of 1.5 Tesla CMR scanners
Summary
There are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging. The aim of this prospective, single-center, observational study was to evaluate artefacts on cardiovascular magnetic resonance (CMR) images in patients with LCP. Potential hazards for patients with conventional cardiac pacemakers undergoing magnetic resonance imaging (MRI) are radiofrequency-induced heating of lead tips, pacing dysfunction and changes in capture threshold [2]. Leadless cardiac pacemaker (LCP) therapy was recently introduced clinically to overcome complications in transvenous pacemaker therapy, such as lead dislogdement and perforation with pericardial effusion, pocket hematoma and device infections [12,13,14]. The MicraTM LCP (Medtronic, Minneapolis, USA), which was investigated in this study, is a MRI conditional cardiac, single chamber pacemaker. The device sizes of 25.9 × 6.7 mm with an integrated lithium silver vanadium oxide, carbon monofluoride battery covered in titanium and is fixed with self-expanding nitinol tines in the right ventricle (RV) [14]
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