Multicenter study of the safety and effects of magnetic resonance imaging in patients with coronary sinus left ventricular pacing leads.

BACKGROUND: Magnetic resonance imaging (MRI) in patients with left ventricular (LV) leads may cause tissue or lead heating, dislodgment, venous damage, or lead dysfunction. OBJECTIVE: The purpose of this study was to determine the safety of MRI in patients with LV pacing leads. METHODS: Prospective data on patients with coronary sinus LV leads undergoing clinically indicated MRI at 3 institutions were collected. Patients were not pacemaker-dependent. Scans were performed under pacing nurse, technician, radiologist, and physicist supervision using continuous vital sign, pulse oximetry, and ECG monitoring and a 1.5-T scanner with specific absorption rate <1.5 W/kg. Devices were interrogated pre- and post-MRI, programmed to asynchronous or inhibition mode with tachyarrhythmia therapies off (if present), and reprogrammed to their original settings post-MRI. RESULTS: MRI scans (n = 42) were performed in 40 patients with non-MRI conditional LV leads between 2005 and 2013 (mean age 67 ± 9 years, n = 16 [40%] women, median lead implant duration 740 days with interquartile range 125-1173 days). MRIs were performed on the head/neck/spine (n = 35 [83%]), lower extremities (n = 4 [10%]), chest (n = 2 [5%]), and abdomen (n = 1 [2%]). There were no overall differences in pre- and post-MRI interrogation LV lead sensing (12.4 ± 6.2 mV vs 12.9 ± 6.7 mV, P = .38), impedance (724 ± 294 Ω vs 718 ± 312 Ω, P = .67), or threshold (1.4 ± 1.1 V vs 1.4 ± 1.0 V, P = .91). No individual LV lead changes required intervention. CONCLUSION: MRI scanning was performed safely in non-pacemaker-dependent patients with coronary sinus LV leads who were carefully monitored during imaging without clinically significant adverse effect on LV lead function.

Atrioesophageal fistula during cryoballoon ablation for atrial fibrillation.

To date, there is 1 case report publication of AE fistula during the employment of the first-generation cryoballoon (Gen-1). Recently the Arctic Front Advance system (second-generation cryoballoon) was introduced into the US and EU markets. For the purpose of peer education, we report a case of AE fistula that occurred during the utilization of the second-generation cryoballoon (Gen-2). Additionally, we review current best practices that may reduce the risk of AE fistula during any AF ablation procedure.

Limitations of the DF-4 defibrillator connector necessitating device removal.

The DF-4 implantable defibrillator connector was recently released for clinical practice. This connector facilitates lead to device connection, reduces bulk in the device pocket, and eliminates the risk of incorrect device connection. Unfortunately, new technology often introduces new challenges. We report the case of a 63-year-old male with chronic systolic heart failure referred for cardiac resynchronization therapy-defibrillator implant. Limitations implicit to the current iteration of this technology include a lack of additional connectivity. In the present case, these limitations ultimately warranted device removal and reimplant with a traditional trifurcating IS-1/DF-1 connector.