Thorac Cardiovasc Surg 2013; 61 - P7
DOI: 10.1055/s-0033-1354498

Preliminary Results of CMR in Nine Patients with Congenital Heart Disease and MRI-Conditional Pacemaker Systems

N Al-Wakeel 1, D O h-Ici 1, D Messroghli 1, E Riesenkampff 1, F Berger 1, T Kuehne 1, B Peters 1
  • 1Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin

Introduction: Pacemakers (PM) have long been considered a contraindication for MRI. The development of MRI-conditional PMs now allows for usage of this valuable imaging tool in patients with PMs. The authors present preliminary results of CMR in CHD patients with MRI-conditional PMs.

Methods: CMR was performed under observance of a SAR ≤2 W/kg in CHD patients with MRI-conditional PMs and a clinical indication for CMR. PM function was assessed pre- and post-CMR. Two experienced investigators evaluated image quality (IQ), considering artifacts caused by PM device and leads, and diagnostic value (DV) of each examination using a 4-point grading scale according to Naehle et al.1

Results: A total of 11 CMR studies was conducted in nine patients (mean age 34.0 y) with dTGA after atrial redirection (n= 3), ccTGA (n= 2), TOF (n= 1), and DORV with PS (n= 1) after surgical correction, and PAPVC (n= 1) and TAPVC (n= 1) after anatomical repair. Sinus node dysfunction (n= 6) and complete AV block (n= 3) had previously led to PM implantation. No PM-related sensations occurred and device parameters remained stable during and after CMR. Good IQ allowed for successful assessment of clinical questions in all cases. Function of systemic RVs could be measured accurately. Detection of peripheral branch stenosis by CMR resulted in RPA stenting in the TOF patient. Follow-up CMR in the DORV patient showed stable RV volumes, and thus, percutaneous pulmonary valve implantation could be postponed. CMR confirmed suspected residual PAPVC after surgical repair, but flow measurements revealed no significant left-to-right shunt, so reoperation was not indicated.

Conclusions: MRI-conditional PMs facilitate safe performance of CMR with good IQ and DV in PM-dependent patients with CHD. Thus, all CHD patients who need implantation or revision of transvenous PMs should be considered for MRI-conditional PM systems.

Reference:

[1] Naehle CP, Kreuz J, Strach K, et al. Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T. Am Heart J 2011;161(6):1096 – 1105