Rofo 2017; 189(03): 204-217
DOI: 10.1055/s-0043-102029
Consensus Paper
© Georg Thieme Verlag KG Stuttgart · New York

MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators[*]

Consensus Paper of the German Cardiac Society and the German Roentgen SocietyArticle in several languages: English | deutsch
Torsten Sommer
1  Klinik für Diagnostische und Interventionelle Radiologie, DRK Krankenhaus Neuwied – Department of Diagnostic and Interventional Radiology, German Red Cross Hospital Neuwied, Germany
,
Wolfgang Bauer
2  Med. Klinik und Poliklinik I Univ. Klinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz Univ. Würzburg – Department of Internal Medicine I, University Hospital Würzburg, Germany, Center for Heart Failure Research, University of Würzburg, Germany
,
Katharina Fischbach
3  Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg – Department of Radiology and Nuclearmedicine, University Hospital Magdeburg, Germany
,
Christof Kolb
4  Klinik für Herz- und Kreislauferkrankungen, Deutsche Herzzentrum Muenchen, Muenchen, Deutschland– Department of Cardiology, German Heart Center Munich, Germany
,
Roger Luechinger
5  Institut für Biomedizinische Technik, Universität und ETH Zürich – Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
,
Uwe Wiegand
6  Klinik für Kardiologie, Schwerpunkt Rhythmologie und Elektrophysiologie, Sana-Klinikum Remscheid, Remscheid – Department of Cardiology,Rhytmology and Electrophysiology, Sana-Clinics Remscheid, Remscheid, Germany
,
Joachim Lotz
7  Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen – Diagnostic and Interventional Radiology, University Hospital Göttingen, Germany
,
Ingo Eitel
8  Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH) – Department of Internal Medicine II (Cardiology, Angiology, Intensive Care) University Heart Center Luebeck, University Hospital, Schleswig-Holstein, Germany
,
Matthias Gutberlet
9  Department of Diagnostic and Interventional Radiology, University of Leipzig – German Heart Center Leipzig, Germany
,
Holger Thiele
10  Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH) – Department of Internal Medicine II (Cardiology, Angiology, Intensive Care) University Heart Center Luebeck, University Hospital, Schleswig-Holstein, Germany
,
Hans H. Schild
11  Radiologische Klinik, Unversitätsklinikum Bonn – Department of Radiology, University Hospital Bonn, Germany
,
Malte Kelm
12  Klinik für Kardiologie, Pneumologie und Angiologie, Universitaetsklinikum Duesseldorf, Duesseldorf –Department of Cardiology, Pneumolgy and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
,
Harald H. Quick
13  Hochfeld- und Hybride MR-Bildgebung, Universitätsklinikum Essen, Essen; Erwin L. Hahn Institut für MR-Bildgebung, Universität Duisburg-Essen, Essen – High Field and Hybrid MR Imaging, University Hospital Essen; Erwin L. Hahn Institute for MR Imaging, Germany
,
Jeanette Schulz-Menger
14  Experimental Clinical Research Center, Kardiologie, Charité Campus Buch, ECRC, Universitätsmedizin Berlin, Berlin, Deutschland, HELIOS Klinikum Berlin-Buch, Klinik für Kardiologie und Nephrologie, Deutschland – Experimental Clinical Research Center,Cardiology, Charité Campus Buch, University Medicine Berlin Germany, HELIOS Clinics Berlin-Buch, Department Cardiology and Nephrology, Berlin, Germany
,
Jörg Barkhausen
15  Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein – Department of Radiology and Nuclearmedicine, University Hospital Luebeck, Germany
,
Dietmar Bänsch
16  Klinik für Innere Medizin/Kardiologie KMG-Kliniken Güstrow, Deutschland – Department of Internal Medicine/Kardiology, KMG Hospital Guestrow, Germany
› Author Affiliations
Further Information

Publication History

08 January 2017

31 January 2017

Publication Date:
15 February 2017 (online)

Abstract

This joint consensus paper of the German Roentgen Society and the German Cardiac Society provides physical and electrophysiological background information and specific recommendations for the procedural management of patients with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD) undergoing magnetic resonance (MR) imaging. The paper outlines the responsibilities of radiologists and cardiologists regarding patient education, indications, and monitoring with modification of MR sequences and PM/ICD reprogramming strategies being discussed in particular. The aim is to optimize patient safety and to improve legal clarity in order to facilitate the access of SM/ICD patients to MR imaging.

Key Points:

  • Conventional PM and ICD systems are no longer an absolute but rather a relative contraindication for performing an MR examination. Procedural management includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific risks and “off label” use, extensive PM/ICD-related and MR-related safety precautions to reduce these risks to the greatest extent possible, as well as adequate monitoring techniques.

  • MR conditional pacemaker and ICD systems have been tested and approved for MR examination under specific conditions (“in-label” use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety.

  • The risk for an ICD patient during MR examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems. The indication for a MR examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/benefit ratio should be critically reviewed.

  • This complex subject requires close collaboration between radiology and cardiology.

Citation Format

  • Sommer T, Bauer W, Fischbach K et al. MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators. Fortschr Röntgenstr 2017; 189: 204 – 217

* The German language version of this article is simultaneously published in issue 2/2017 of “Der Kardiologe”.