Pulver Aaron F, Puchalski Michael D, Bradley David J, Minich L Luann, Su Jason T, Saarel Elizabeth V, Whitaker Patricia, Etheridge Susan P
Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA.
Pacing Clin Electrophysiol. 2009 Apr;32(4):450-6. doi: 10.1111/j.1540-8159.2009.02304.x.
Magnetic resonance imaging (MRI) is a standard of care in evaluating many disease processes. Given concerns about device damage or movement, programming changes, lead heating, inappropriate pacing, and image artifact, MRI is contraindicated in pacemaker patients. Despite this, studies have demonstrated safety and efficacy of MRI in adults with acquired heart disease and endocardial pacing leads. We sought to evaluate MRI use in congenital heart disease (CHD) patients with predominantly epicardial pacing leads.
From July 2007 to October 2008, MRI (1.5 Tesla) was performed in 11 patients without alternative imaging modality who were not pacemaker dependent or possessing abandoned leads. Pacing was disabled during MRI. An electrophysiologist monitored electrocardiogram and hemodynamic parameters throughout each study. Device and lead function were evaluated before and after MRI, and at subsequent clinic visits.
Eleven MRIs (four cardiac, seven noncardiac) were performed in eight patients. Mean patient age was 16.5 +/- 9.2 years (range 1.7-24.5) with five patients under the age of 16 years. Diagnoses included structural CHD in six patients and long QT syndrome and congenital heart block in one each. There were three dual- and five single- (three atrial, two ventricular) chamber devices, two endocardial, and nine epicardial leads. No inappropriate pacing or significant change in generator or lead parameters was noted. All MRI studies were of diagnostic quality.
Diagnostic quality MRI can be performed safely in nonpacemaker-dependent CHD patients with predominantly epicardial leads. Further studies will define safe practice measures in this population, as well as in CHD patients with pacemaker dependency.
磁共振成像（MRI）是评估多种疾病过程的标准医疗手段。鉴于对设备损坏或移动、程序更改、导线发热、不适当起搏及图像伪影的担忧，MRI在起搏器患者中属禁忌。尽管如此，研究已证明MRI在患有后天性心脏病及心内膜起搏导线的成人中具有安全性和有效性。我们旨在评估MRI在主要采用心外膜起搏导线的先天性心脏病（CHD）患者中的应用情况。
2007年7月至2008年10月，对11例不依赖起搏器或无废弃导线且无其他成像方式可供选择的患者进行了MRI（1.5特斯拉）检查。MRI检查期间停用起搏功能。在每项研究过程中，一名电生理学家监测心电图和血流动力学参数。在MRI检查前后及随后的门诊就诊时评估设备和导线功能。
8例患者共进行了11次MRI检查（4次心脏检查，7次非心脏检查）。患者平均年龄为16.5±9.2岁（范围1.7 - 24.5岁），其中5例年龄小于16岁。诊断包括6例结构性CHD、1例长QT综合征和1例先天性心脏传导阻滞。有3台双腔和5台单腔（3台心房、2台心室）设备，2根心内膜导线和9根心外膜导线。未发现不适当起搏或发生器或导线参数有显著变化。所有MRI检查均具有诊断质量。
对于主要采用心外膜导线且不依赖起搏器的CHD患者，可安全地进行具有诊断质量的MRI检查。进一步的研究将确定该人群以及依赖起搏器的CHD患者的安全操作措施。
