In the right clinical setting with an experienced team of cardiovascular MRI specialists, many patients with implantable devices can safely undergo MRI, Dr. Biederman said.
Pittsburgh, PA (PRWEB) May 30, 2013
Cardiovascular imaging specialists at Allegheny General Hospital (AGH) have launched an innovative clinical protocol that for the first time in the region is allowing patients with heart pacemakers and implantable cardioverter defibrillators (ICD) to undergo magnetic resonance imaging (MRI) studies.
One of just a handful of U.S. medical centers with the advanced capability of performing MRI on patients with implantable cardiac devices, AGH’s new program addresses a major health issue that affects many people, according to Robert Biederman, MD, Medical Director of the Cardiovascular MRI Center at AGH’s Cardiovascular Institute.
Approximately three million Americans currently have an implanted cardiac device and hundreds of thousands more receive them each year.
Though it is estimated that 50-75% of people who have a pacemaker or ICD will require an MRI during their lifetime to help physicians diagnosis disease or evaluate critical injuries, the presence of the implanted devices has historically prohibited the use of MRI as a diagnostic tool.
Dr. Biederman said the concern is that the powerful magnetic and radio frequency fields generated during MRI might damage the implanted device and harm the patient.
“So we essentially have two life-saving technologies that for decades now have been completely incompatible with each other. It is a clinical dilemma, with potential grave consequences, that physicians face every day in hospitals around the country,” Dr. Biederman said.
And while new generation pacemakers are currently being developed specifically for MRI compatibility, Dr. Biederman said the vast majority of people have or continue to receive conventional devices that are not conditioned for MRI.
“Fortunately, a number of prominent cardiovascular and radiology programs around the country, including ours, have been focused on this challenge for some time and great progress has been made in developing protocols that minimize MRI’s risks to patients with these implanted devices,” he said.
Under Dr. Biederman’s direction, patients with implanted cardiac devices who are referred for MRI at the hospital undergo an extensive evaluation of their cardiovascular health and level of device dependence.
Once a patient is cleared to undergo MRI, Dr. Biederman and his team perform a baseline device interrogation and then convert the pacemaker to a safer mode of operation for the length of the test. If patients are determined to be non-pacemaker dependent under baseline conditions, the device may be turned off completely while the imaging takes place.
During the procedure, a patient’s heart rhythm is monitored in real-time in the MRI suite and the entire process is closely supervised by Dr. Biederman, a cardiovascular physicist and the Cardiovascular MRI Center’s team of nurses and technologists. Once the MRI is completed, the implanted device is reprogrammed to its original settings.
To date, 45 patients with implantable devices have undergone MRI studies at AGH for a variety of serious clinical indications. In a recent presentation to the Society of Cardiovascular MRI detailing the team’s early experience with the new pacemaker/MRI protocol, Dr. Biederman reported no adverse clinical events associated with it. Moreover, he demonstrated that in fully two-thirds of the cases significant life-saving or life-changing diagnoses were made based on results of the MRI.
“The MRI made a dramatic impact on patient care decisions in these cases,” he said.
AGH is also a key participant in the MagnaSafe Registry, the nation’s largest multi-center, prospective study exploring the safety and efficacy of MRI for patients with implanted cardiac devices. The study is being coordinated by the Scripps Clinic in La Jolla, CA.
At the American College of Cardiology annual meeting in February 2013, lead investigator Robert Russo, MD, PhD, of Scripps Clinic, announced preliminary results for the Registry’s first 829 cases, demonstrating no deaths, device failures, ventricular arrhythmias or losses of image capture during MRI.
“The evidence so far, both from our program and the national study exploring this protocol, has been quite definitive. In the right clinical setting with an experienced team of cardiovascular MRI specialists, many patients with implantable devices can safely undergo MRI,” Dr. Biederman said.
So far, the majority of those who have benefited from the AGH pacemaker/MRI program have been hospitalized patients considered to have a critical need for the advanced diagnostic capability MRI affords, Dr. Biederman said.
“Our early focus has been on imaging those patients for whom MRI is a last resort option that physicians believe can make a significant difference in the direction of their care and ultimate outcome. We’ll continue to reserve this new protocol for those high-risk cases, while exploring its efficacy among less infirmed patients via the MagnaSafe Study,” he said.
Those who would like more information about the MagnaSafe Registry or AGH’s pacemaker/MRI program can call cardiovascular MRI research coordinator Andrea Jacobs at 412-359- 4631 or Dr. Biederman at 412-359-8009