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Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ.

Quarta G, Holdright DR, Plant GT, Harkness A, Hausenloy D, Hyare H, Moon JC - J Cardiovasc Magn Reson (2011)

Bottom Line: Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI).Cardiac and brain MRI were requested to guide immunosupression.Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, London, UK.

ABSTRACT
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.

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Chest radiograph (left) and magnified image (right) of pacemaker. White arrows show the MRI-conditional marker on the header of the can (long arrow and schematic) and similar wavy line marker on the leads (short arrows).
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Figure 1: Chest radiograph (left) and magnified image (right) of pacemaker. White arrows show the MRI-conditional marker on the header of the can (long arrow and schematic) and similar wavy line marker on the leads (short arrows).

Mentions: A 53 year old woman presented with fatigue in complete heart block. Transthoracic echocardiography was normal. Six years previously, neuro-sarcoidosis presenting with diplopia and hydrocephalus had been confirmed by meningeal biopsy, and an MRI-conditional programmable Ventriculo-Peritoneal shunt (PS Medical Strata® valve, Medtronic) had been inserted. In view of her ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads (Advisa DR MRI™ SureScan™ with 5086 leads, Medtronic, Figure 1) were implanted. Subsequently, in September 2010, cardiac and brain MRI were requested to guide immunosupression. Following appropriate protocols for both MRI conditional devices, interleaved pre and post contrast cardiac, brain, and orbit MRI were performed in one session at 1.5T. Prior to scanning, the pacemaker was interrogated, lead integrity checked and device switched to DOO mode at 60 bpm at 5V@1ms (from 2V@0.4ms). Post scanning, all pacemaker parameters were unaffected, and normal operation was reprogrammed. Similarly, the programmable VP shunt, whose settings alter with scanning, was reset.


Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ.

Quarta G, Holdright DR, Plant GT, Harkness A, Hausenloy D, Hyare H, Moon JC - J Cardiovasc Magn Reson (2011)

Chest radiograph (left) and magnified image (right) of pacemaker. White arrows show the MRI-conditional marker on the header of the can (long arrow and schematic) and similar wavy line marker on the leads (short arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108926&req=5

Figure 1: Chest radiograph (left) and magnified image (right) of pacemaker. White arrows show the MRI-conditional marker on the header of the can (long arrow and schematic) and similar wavy line marker on the leads (short arrows).
Mentions: A 53 year old woman presented with fatigue in complete heart block. Transthoracic echocardiography was normal. Six years previously, neuro-sarcoidosis presenting with diplopia and hydrocephalus had been confirmed by meningeal biopsy, and an MRI-conditional programmable Ventriculo-Peritoneal shunt (PS Medical Strata® valve, Medtronic) had been inserted. In view of her ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads (Advisa DR MRI™ SureScan™ with 5086 leads, Medtronic, Figure 1) were implanted. Subsequently, in September 2010, cardiac and brain MRI were requested to guide immunosupression. Following appropriate protocols for both MRI conditional devices, interleaved pre and post contrast cardiac, brain, and orbit MRI were performed in one session at 1.5T. Prior to scanning, the pacemaker was interrogated, lead integrity checked and device switched to DOO mode at 60 bpm at 5V@1ms (from 2V@0.4ms). Post scanning, all pacemaker parameters were unaffected, and normal operation was reprogrammed. Similarly, the programmable VP shunt, whose settings alter with scanning, was reset.

Bottom Line: Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI).Cardiac and brain MRI were requested to guide immunosupression.Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, London, UK.

ABSTRACT
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.

Show MeSH
Related in: MedlinePlus