磁共振成像兼容起搏器临床应用随访

目的观察磁共振成像(MRI)兼容心脏起搏器的临床应用情况和MRI扫描的安全性。方法对浙江大学医学院附属第一医院植入MRI兼容起搏器的患者进行随访,观察记录植入术后MRI扫描情况及起搏器各项参数变化。结果共447例患者植入MRI兼容起搏器,植入前56例次患者曾行过MRI检查;植入后9例次行1. 5T MRI扫描,1例次行3. 0T MRI扫描。扫描部位包括:头部8例次、肝胆1例次、脊柱1例次。扫描前后起搏器各项参数变化无统计学意义,MRI成像清晰。随访至MRI检查后6个月,未发现起搏器工作异常及电量异常耗损。结论 MRI兼容起搏器植入呈上升趋势,在规范的操作流程下,患者能安全有效地进行MRI扫描。     

兼容核磁共振双腔心脏起搏器植入的临床应用研究

目的观察兼容核磁共振(MRI)双腔心脏起搏器围手术期以及术后MRI检查的安全性。方法 MRI兼容双腔起搏器组(简称MRI组)植入Medtronic双腔心脏起搏器A3DR01,对照组为同期植入了Medtronic非MRI兼容双腔起搏器。观察术中、术后随访及MRI检查前后起搏器参数等情况。结果MRI组50例[男性22例(44%),年龄(74±8)岁]患者均成功植入A3DR01起搏器,对照组共128例[57例男性(44.5%),年龄(58±12)岁]植入非MRI兼容双腔起搏器。两组手术时间、射线时间和围手术期并发症无显著差异。术后随访,MRI组9例(18%)患者术后共行13次MRI扫描(3次头颅,2次胸部和6次腰椎),其中1例共行4次腰椎MRI扫描,无MRI检查相关并发症出现,均未见起搏阈值增高、感知异常及导线移位、心肌穿孔等情况。结论兼容MRI双腔心脏起搏器植入术中安全可行,术后能安全进行MRI扫描。     

心脏起搏器更换原因分析

1981年5月至2004年7月,我院对159例患者安装永久性心脏起搏器,累计更换起搏器196例次.现将起搏器更换原因分析如下.     

腹腔镜术后发现起搏器工作模式改变一例

1例73岁女性,安装双腔心脏起搏器2年,经腹腔镜左肾上腺瘤切除术后,起搏器工作模式由DDDR变为VVI,经程控后恢复,随访3个月起搏器正常。提示:心脏起搏器患者使用电刀应注意对起搏器的影响。     

486例埋藏起搏器随访及135例更换起搏器的临床报告

本文总结486例埋藏式心脏起搏器随访20年和135例起搏器的更换资料。结果表明有病态窦房结综合征及传导障碍而无严重心脏病变者安置起搏器,其寿命可如常人。更换起搏器时应酌情安置临时心脏起搏器,以防止心脏意外的发生。对早期进口起搏器(Edwards 30)建议埋植7年左右即予更换。     

高龄VVI心脏起搏器植入者心力衰竭的影响因素

永久起搏器植入目前已经成为缓慢性心律失常的常规治疗手段之一.据统计[1],我国起搏器植入总数年平均增长11％左右,其中老年患者所占比例超过所有起搏器植入患者总数的76％.迄今为止,传统右室心尖起搏在临床上仍广泛应用[2].由于高龄患者基础疾病较多,心脏起搏器植入后发生心力衰竭的风险增加,致使死亡率增高.本实验通过对VVI心脏起搏器植入后发生心力衰竭的高龄患者伴发疾病进行分析,探讨影响心力衰竭发生的相关因素以指导其预防及治疗.     

老年肥厚型心肌病心房颤动患者应用抗心房颤动起搏器治疗成功一例

患者男性,77岁.肥厚型梗阻性心肌病于8年前安置双腔永久性心脏起搏器,因起搏器电池耗竭于2005年4月2日来我院更换起搏器.     

永久心脏起搏器置入患者合并心理问题现状分析

目的 了解置入永久心脏起搏器患者合并心理问题的现状.方法 入选置入永久心脏起搏器患者226例(起搏器组)和健康体检者184例(对照组).应用Zung焦虑自评量表和Zung抑郁自评量表分别在起搏器组入院时、手术后3 d、出院后90 d和对照组体检时心理状态进行评估与比较.结果 起搏器组患者入院时有焦虑症状和抑郁症状分别占...     

永久性心脏起搏器植入术后感染患者的护理

永久性心脏起搏器是缓慢性心律失常的有效治疗方法。但随着接受起搏器植入的患者不断增加,起搏器相关感染的发生率也较前增加。起搏器相关感染不仅影响患者的健康及生活质量,严重时甚至会威胁患者生命。因此,起搏器植入术后正确的护理方法及护理指导对患者的早日康复非常重要。本研究对2005年至2013年在我中心确诊为植入性心脏起搏器感染的患者护理措施进行了总结。     

心脏起搏器植入对中年患者生活质量影响的调查分析与护理干预

永久性心脏起搏器是治疗各种原因引起的不可逆的心脏起搏与传导功能障碍性疾病的主要方法。起搏器一旦植入必将伴随患者终生，成为保障患者生命安全的重要工具。至2006年全国心脏起搏器植入已超过23000台。近几年我国起搏器植入者中中年患者人数每年递增。他们对起搏器植入术的疑虑及心理压力反映特别强烈，     

Not All Pacemakers Are Created Equal: MRI Conditional Pacemaker and Lead Technology

Due to expanding clinical indications and an aging society there has been an increase in the use of implantable pacemakers. At the same time, due to increased diagnostic yield over other imaging modalities and the absence of ionizing radiation, there has been a surge in demand for magnetic resonance imaging (MRI) assessment, of both cardiac and noncardiac conditions. Patients with an implantable device have a 50–75% chance of having a clinical indication for MRI during the lifetime of their device. The presence of an implantable cardiac device has been seen as a relative contraindication to MRI assessment, limiting the prognostic and diagnostic utility of MRI in many patients with these devices. The introduction of MRI conditional pacemakers will enable more patients to undergo routine MRI assessment without risk of morbidity or device malfunction. This review gives a general overview of the principles and current evidence for the use of MRI conditional implantable cardiac devices. Furthermore, we appraise the differences between those pacemakers currently released to market.     

Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging With Cardiac Implantable Electronic Devices

Magnetic resonance imaging (MRI) has historically been considered contraindicated for individuals with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable defibrillators. Magnetic resonance scanners produce magnetic fields that can interact negatively with the metallic components of CIEDs. However, as CIED technology has advanced, newer MRI conditional devices have been developed that are now in clinical use and these systems have had demonstrated safety in the MRI environment. Despite the supportive data of such CIED systems, physicians remain reluctant to perform MRI scanning of conditional devices. This joint statement by the Canadian Heart Rhythm Society and the Canadian Association of Radiologists describes a collaborative process by which CIED specialists and clinics can work with radiology departments and specialists to safely perform MRI in patients with MRI conditional CIED systems. The steps required for patient and scanning preparation and the roles and responsibilities of the CIED and radiology departments are outlined. We also briefly outline the risks and a process by which patients with nonconditional CIEDs might also receive MRI in highly specialized centres. This document supports MRI in patients with MRI conditional CIEDs and offers recommendations on how this can be implemented safely and effectively.     

2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society

Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.     

磁共振兼容起搏器的临床应用

心血管植入性电子装置（cardiovascular implantable electronic devices,CIED）和磁共振扫描（magnetic resonance image,MRI）的临床应用逐年增加。50%~75%的CIED患者可能需要MRI检查。但由于MRI检查中的磁场和能量会 导致电子装置不可逆的损害,因此,CIED患者一直是MRI扫描的禁忌。2009年,磁共振兼容起搏器被用于临床。与 传统起搏器相比,磁共振兼容起搏器在脉冲发生器和电极导线构造方面都做了一系列改进,从而大大减少磁场对起 搏系统的影响,使得患者可以安全地接受磁共振扫描。当然,随着临床应用增加,人们对磁共振兼容起搏器认识亟待 提高。文章从磁场对起搏系统的影响,磁共振兼容起搏器构造的改进,不同制造商的磁共振兼容起搏器的特征以及 磁共振兼容起搏器今后的发展进行综述,以提高临床对磁共振兼容起搏器的认识。     

Cardiac magnetic resonance in a patient with MRI-conditional pacemaker

An implanted pacemaker is generally considered a contraindication for magnetic resonance imaging (MRI). The increasing number of indications for MRI and the rising prevalence of implanted cardiac pacemakers have prompted the recent development of MRI-conditional pacemaker systems.We present the case of a 68-year-old woman with left ventricular hypertrophy, hypertension, aortic valve stenosis and a family history of cardiac amyloidosis, who developed complete heart block. In view of the foreseeable need for cardiac MRI, an MRI-conditional dual chamber pacemaker was implanted. The MRI scan confirmed moderate left ventricular hypertrophy and aortic valve stenosis, and showed no delayed enhancement suggestive of amyloid heart disease. This case illustrates the feasibility of cardiac MRI in this setting and the usefulness of the recently introduced MRI-conditional pacemaker systems.     

Usefulness of multidetector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries

An ever-increasing number of patients with congenital heart disease are reaching adulthood; follow-up often requires right ventricular (RV) quantification. Complex anatomy, acoustic window, and active implants such as pacemakers may limit modalities, such as echocardiography and cardiac magnetic resonance imaging (MRI), in this population. Recent advances in multidetector row cardiac computed tomography (MDCT) allow multiphase, multislice reconstructions in any plane but have not been applied to RV quantification. Fourteen patients with tetralogy of Fallot or transposition of the great arteries underwent cardiac MRI and MDCT examinations, with comparable quantification of RV volumes and ejection fractions and no systematic error by Bland-Altman analysis using MRI as the gold standard.     

Pacemaker or ICD and MRI: is MRI safety the new standard?

Recently new models of cardiac pacemakers have been commercialised. Some of these models have the particularity to be compatible with MRI (they are called MRI safe). The safety of the MRI for the patients implanted depends on the device it self and the lead(s). These review article focuses on the benefits and limits of these new devices. A practical guideline is proposed for patients implanted by a pacemaker or ICD and undergoing MRI.     

MRI-Conditional Cardiac Implantable Electronic Devices: What’s New and What Can We Expect in the Future?

OPINION STATEMENT: The use of magnetic resonance imaging (MRI) as a diagnostic technique is rapidly expanding. The number of patients who undergo implantation of permanent pacemaker, implantable cardioverter defibrillator (ICD), and/or cardiac resynchronization therapy devices is increasing in parallel. Cardiovascular implants are subject to potentially harmful effects from MRI, and the routine use of this imaging modality for patients with standard cardiovascular devices is contraindicated. Several recent publications have suggested that MRI can safely be performed in standard cardiovascular device recipients with appropriate patient selection, device programming, and strict monitoring. In addition, MRI "conditional" device systems are now available that are specifically designed to be safe in the MRI environment. Such new technologies may simplify and improve overall safety of MRI in the setting of pacemaker and ICD systems. Although the availability of MRI conditional devices represents a significant breakthrough, their current use is limited to specific MRI conditions. MRI conditional cardiac device technology will likely continue to evolve with increased efforts to improve simplicity, safety, and generalizability under all MRI conditions.     

Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla

OBJECTIVES: The study was done to determine whether patients with pacemakers could safely undergo magnetic resonance imaging (MRI) at 1.5-Tesla (T). BACKGROUND: Because of theoretical risks, it is an absolute contraindication for a patient with a pacemaker to undergo MRI. However, there are times when an MRI is needed to provide valuable clinical information. METHODS: Fifty-four patients underwent a total of 62 MRI examinations at 1.5-T. The type of MRI examination was not limited and included cardiac, vascular, and general MRI studies using various whole-body averaged specific absorption rate (SAR) of radiofrequency power. Restrictions were not placed on the type of pacemaker present in the patient. All pacemakers were interrogated immediately before and after MRI scanning, and patients were continuously monitored. Before and after MRI, interrogation was done, and pacing and sensing thresholds, as well as lead impedances, were all measured. RESULTS: A total of 107 leads and 61 pulse generators were evaluated. No adverse events occurred. Forty (37%) of the leads underwent changes, whereas 10 (9.4%) leads underwent a significant change. Only 2 of the 107 (1.9%) leads required a change in programmed output. Threshold changes were unrelated to cardiac chamber, anatomical location, peak SAR, and time from lead implant to the MRI examination. Electrocardiographic changes and patient symptoms were minor and did not require cessation of MRI. CONCLUSIONS: Safety was demonstrated in this series of patients with pacemakers at 1.5-T.     

Safety Of Mris In Patients With Pacemakers And Defibrillators

With a burgeoning population, increases in life expectancy, and expanding indications, the number of patients with cardiac devices such as pacemakers and implantable cardioverter defibrillators continues to increase each year. A majority of these patients will develop an indication for magnetic resonance imaging (MRI) in their lifetime. MRIs have established themselves as one of the most powerful imaging tools for a variety of conditions. However, given the historic safety concerns, many physicians are reluctant to use MRIs in this patient population. In this paper, we discuss the potential adverse effects of MRIs in patients with cardiac devices, review key studies that have addressed strategies to limit adverse effects, and provide our cardiovascular MRI laboratory’s protocol for imaging patients with implanted cardiac devices.