Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator.

BACKGROUND: The presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverter-defibrillator (ICD) that was "non-MRI-conditional" (i.e., not approved by the Food and Drug Administration for MRI scanning). METHODS: Patients in the registry were referred for clinically indicated nonthoracic MRI at a field strength of 1.5 tesla. Devices were interrogated before and after MRI with the use of a standardized protocol and were appropriately reprogrammed before the scanning. The primary end points were death, generator or lead failure, induced arrhythmia, loss of capture, or electrical reset during the scanning. The secondary end points were changes in device settings. RESULTS: MRI was performed in 1000 cases in which patients had a pacemaker and in 500 cases in which patients had an ICD. No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI. One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI. We observed six cases of self-terminating atrial fibrillation or flutter and six cases of partial electrical reset. Changes in lead impedance, pacing threshold, battery voltage, and P-wave and R-wave amplitude exceeded prespecified thresholds in a small number of cases. Repeat MRI was not associated with an increase in adverse events. CONCLUSIONS: In this study, device or lead failure did not occur in any patient with a non-MRI-conditional pacemaker or ICD who underwent clinically indicated nonthoracic MRI at 1.5 tesla, was appropriately screened, and had the device reprogrammed in accordance with the prespecified protocol. (Funded by St. Jude Medical and others; MagnaSafe ClinicalTrials.gov number, NCT00907361 .).

Determining the risks of magnetic resonance imaging at 1.5 tesla for patients with pacemakers and implantable cardioverter defibrillators.

Conventional pacemaker and implantable cardioverter-defibrillator product labeling currently cautions against exposure to magnetic resonance imaging (MRI). However, there is a growing clinical need for MRI, without an acceptable alternative imaging modality in many patients with cardiac devices. The purpose of this study was to determine the risk of MRI at 1.5 T for patients with cardiac devices by measuring the frequency of device failures and clinically relevant device parameter changes. Data from a single-center retrospective review of 109 patients with pacemakers and implantable cardioverter-defibrillators (the MRI group) who underwent 125 clinically indicated MRI studies were compared to data from a prospective cohort of 50 patients with cardiac devices who did not undergo MRI (the control group). In the MRI group, there were no deaths, device failures requiring generator or lead replacement, induced arrhythmias, losses of capture, or electrical reset episodes. Decreases in battery voltage of ≥0.04 V occurred in 4%, pacing threshold increases of ≥0.5 V in 3%, and pacing lead impedance changes of ≥50 Ω in 6%. Although there were statistically significant differences between the MRI and control groups for the mean change in pacing lead impedance (-6.2 ± 23.9 vs 3.0 ± 22.1 Ω) and left ventricular pacing threshold (-0.1 ± 0.3 vs 0.1 ± 0.2 V), these differences were not clinically important. In conclusion, MRI in patients with cardiac devices resulted in no device or lead failures. A small number of clinically relevant changes in device parameter measurements were noted. However, these changes were similar to those in a control group of patients who did not undergo MRI.

Phylogenetic Relationships of Xylella fastidiosa Strains Isolated from Landscape Ornamentals in Southern California.

ABSTRACT Xylella fastidiosa is an insect-borne, xylem-limited pathogenic bacterium that has been associated with a rise in incidence of diseased landscape ornamentals in southern California. The objective of this study was to genetically characterize strains isolated from ornamental hosts to understand their distribution and identity. Strains of X. fastidiosa isolated from ornamentals were characterized using a multiprimer polymerase chain reaction (PCR) system, random amplified polymorphic DNA (RAPD)-PCR, and sequence analysis of the 16S-23S rDNA intergenic spacer region (ISR). Based on RAPD-PCR and 16S-23S rDNA ISR, strains isolated from daylily, jacaranda, and magnolia clustered with members of X. fastidiosa subsp. sandyi and caused oleander leaf scorch but not Pierce's disease symptoms in glasshouse assays on oleander and grape, respectively. This demonstrated both that our groupings based on genetic characterization were valid and that strains of X. fastidiosa subsp. sandyi are present in hosts other than oleander. Strains isolated from Spanish broom, cherry, and one strain isolated from western redbud clustered with X. fastidiosa subsp. fastidiosa members. Strains isolated from purple-leafed plum, olive, peach, plum, sweetgum, maidenhair tree, crape myrtle, and another western redbud strain clustered with members of X. fastidiosa subsp. multiplex. All strains isolated from mulberry and one from heavenly bamboo formed a separate cluster that has not yet been defined as a subspecies.

Response of Argentine ants and red imported fire ants to permethrin-impregnated plastic strips: foraging rates, colonization of potted soil, and differential mortality.

This study investigated the effects of the permethrin-impregnated plastic on ant mortality and foraging rates, and tested its potential for preventing ants from colonizing potted soil. Direct exposure to the plastic for as short as 1 min caused significant mortality of both red imported fire ants, Solenopsis invicta Buren, and Argentine ants, Linepithema humile (Mayr); however, red imported fire ants were more susceptible than Argentine ants. Knockdown of virtually all ants initially occurred within 15 min after exposure. However, some moribund ants recovered from the effects within 24 h. For example, after 1 min of direct exposure to the permethrin-impregnated plastic, 70% of Argentine ants and 5% of red imported fire ants recovered from the treatment. In established colonies of Argentine ants, significantly fewer ants foraged for food up posts treated with the plastic compared with untreated posts. In addition, colonies responded to introduction of the treatment by significantly reducing their overall foraging rates, even on untreated posts. When pots filled with moistened soil were introduced into established ant colonies, 82% of Argentine ants and 99% of red imported fire ants moved into the soil. In contrast, when a 1-cm-wide coil of the plastic was placed under the pot, no ants moved into the soil. The potential for use of these materials in nursery production is discussed.