Introduction:
The evolution of pacemaker/ICD safety in the magnetic field has triggered considerable interest in more clinical routine use. However, many limitations to widespread adoption of this seemingly implausible idea just a few years ago remain: unresolved impact of the high magnetic field, RF amplitude and oscillatory forces on electronics with possible high field damage to capacitor, solenoid and microcircuitry. However, given recent vender refinements over the last 10 years, we hypothesized that the impact on such circuitry may be far less than expected.
Method:
Consecutive interrogation of 940 pts who underwent clinically indicated MRI were evaluated over 5 years. This cohort was comprised of neuro/neurosurgical (72%), orthopedic (11%) and cardiac (17%) cases. Routine interrogation was performed within 10 min of entry into the bore of a dedicated Cardiac MRI (GE, 1.5T, WI). As well, reinterrogation was performed within 10 min of departure MRI (average 21±12min). At the time of interrogation pre and post MRI, a separate, repeat interrogation was performed within 5 min of each other such that 2 sets of PM/ICD parameters were obtained pre and post MRI.
Result:
No complications to either pt or device occurred during the MRI comprising 564 PMs and 376 ICDs. A cardiologist was present guiding the interrogation, configuration, and reconfiguration of the PM/ICD as well was present for entire MRI. There were no significant differences in common clinical parameters. More importantly, there was no difference in any parameter when compared in any order pre to post MRI scan. See Table.
Conclusion:
Intrinsic variability and inherent changes triggered by MRI environments are clinically insignificant and statistically negligible thereby removing yet another of the last remaining fears and apprehensions for primary PM/ICD failure and destruction as we move towards a more uniform acceptance of this technology for clinically meaningful use, dissemination and acceptance.
Design for a Persistent Current Switch Controlled by Alternating Current Magnetic Field
