RESUMO
BACKGROUND: Utilization of cardiac magnetic resonance imaging (cMRI) as an imaging modality in clinical practice is rapidly increasing. More evidence from randomized studies establishing clinical safety and performance of pacing systems in patients undergoing a cMRI scan is needed. OBJECTIVES: The purpose of this prospective, multicenter, randomized study was to demonstrate safety and efficacy of the Accent MRI™ conditional pacing systems (St. Jude Medical, St. Paul, MN, USA) in patients undergoing cMRI scan. METHODS: Patients (n = 283) indicated for dual-chamber pacemaker implant were randomized to either the MRI Group (MG) (n = 140) or the Control Group (CG) (n = 143) after successful device implantation of the Accent MRI™ system. Clinical evaluation and device interrogation were performed at pre- and post-MRI scan, and 1 month post-MRI for all patients. At 9-12 weeks postimplant, patients in MG underwent a nondiagnostic cMRI scan at 1.5 Tesla (T), while patients in CG underwent device interrogation and clinical evaluation twice with a 45-minute waiting period in between. The safety endpoint was freedom from MRI scan-related complications and that for efficacy was significant changes in right atrial/ventricular capture threshold and sensing amplitude between right before MRI, immediately after MRI, and 1 month post-MRI. RESULTS: Results showed 100% freedom from MRI scan-related complications. There were no significant changes in device performance between pre-MRI scan and 1 month post-MRI scan time points in both study groups. CONCLUSIONS: cMRI scanning with 1.5 T scanners is safe in patients implanted with the Accent MRI™ conditional pacing system and has no significant effect on the electrical parameters of the device and leads.
Assuntos
Técnicas de Imagem Cardíaca , Desfibriladores Implantáveis , Imageamento por Ressonância Magnética , Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem Cardíaca/efeitos adversos , Feminino , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Lead dislodgement and migration is a known complication after implantation of cardiac rhythm devices. We present a case of dislodgement of atrial lead of the CRT-D system and its migration into the device pocket. The device itself had rotated by 90 degrees but the right and left ventricular leads were not at all affected. The case is unique because the lead had coiled up and was lying behind the device in the pocket and hence was not even seen on a chest x-ray.