心脏起搏器植入患者进行核磁共振扫描安全性研究
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摘要
目的探讨植入核磁共振(MRI)兼容起搏器患者进行MRI扫描的安全性。方法选取自2013年1月至2017年10月于北部战区总医院植入MRI兼容起搏器并进行1. 5 T的MRI扫描的21例患者为研究对象。观察患者在核磁扫描前、扫描后即刻以及扫描后1、6、12个月的临床不良事件发生情况、起搏器系统稳定性及电极导线的参数变化情况。结果本组患者在MRI扫描过程中,无胸痛、心悸、胸闷、晕厥等不适症状,心电监测未监测到心律失常的发生,MRI扫描后复查的体表心电图与扫描前比较无变化。扫描后即刻程控仪测试脉冲发生器的工作情况,无误感知、超速起搏、脉冲发生器重置等异常现象发生,测试电池电量无损耗,扫描前、扫描后即刻以及扫描后1、6、12个月的电极导线参数未见明显异常变化(P>0. 05)。结论植入MRI兼容的起搏器患者进行1. 5 T的MRI扫描的安全性及稳定性均较好。
Objective To investigate the safety of magnetic resonance imaging( MRI) scan for patients with implantable nuclear magnetic resonance compatible pacemakers. Methods A retrospective study was performed on 21 cases of patients with implantable nuclear magnetic resonance compatible pacemakers who underwent 1. 5 T MRI scanning from January 2013 to October 2017. The clinical adverse events,the stability of pacemaker system and the parameter changes of pacing leads were observed before,immediately after,1,6 and 12 months after MRI scanning. Results In this group of patients,there were no chest pain,palpitations,chest tightness,syncope and other discomfort symptoms in the MRI scanning process,no arrhythmia was detected in the electrocardiogram monitoring,and there was no change in the body surface electrocardiogram after the MRI scanning compared with before the scanning. Scanning program-controlled instrument immediately after testing the performance of the pulse generator,and correct perception,speeding pacemaker,reset pulse generator,such as abnormal phenomenon occurs,the test battery lossless,close follow-up scans before,immediately after scanning,scanning after 1,6,12 months of pacing leads parameters,no obvious changes occured( P > 0. 05). Conclusion Patients implanted with MRI compatible pacemakers who underwent 1. 5 T MRI scanning are safe and stable.
Objective To investigate the safety of magnetic resonance imaging( MRI) scan for patients with implantable nuclear magnetic resonance compatible pacemakers. Methods A retrospective study was performed on 21 cases of patients with implantable nuclear magnetic resonance compatible pacemakers who underwent 1. 5 T MRI scanning from January 2013 to October 2017. The clinical adverse events,the stability of pacemaker system and the parameter changes of pacing leads were observed before,immediately after,1,6 and 12 months after MRI scanning. Results In this group of patients,there were no chest pain,palpitations,chest tightness,syncope and other discomfort symptoms in the MRI scanning process,no arrhythmia was detected in the electrocardiogram monitoring,and there was no change in the body surface electrocardiogram after the MRI scanning compared with before the scanning. Scanning program-controlled instrument immediately after testing the performance of the pulse generator,and correct perception,speeding pacemaker,reset pulse generator,such as abnormal phenomenon occurs,the test battery lossless,close follow-up scans before,immediately after scanning,scanning after 1,6,12 months of pacing leads parameters,no obvious changes occured( P > 0. 05). Conclusion Patients implanted with MRI compatible pacemakers who underwent 1. 5 T MRI scanning are safe and stable.
引文
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[11]吴冬燕,卢凤民,李琼,等.磁共振兼容起搏器的临床应用评价[J].中华心律失常学杂志,2017,21(2):103-106.
[12]Williamson BD,Gohn DC,Ramza BM,et al.Real-World evaluation of magnetic resonance imaging in patients with a magnetic resonance imaging conditional pacemaker system:results of 4-year prospective follow-up in 2,629 patients[J].JACC Clin Electrophysiol,2017,3(11):1231-1239.
[2]Beinart R,Nazarian S.Effects of external electrical and magnetic fields on pacemakers and defibrillators:from engineering principles to clinical practice[J].Circulation,2013,128(25):2799-2809.
[3]Luechinger R,Zeijlemaker VA,Pedersen EM,et al.In vivo heating of pacemaker leads during magnetic resonance imaging[J].Eur Heart J,2005,26(4):376-383.
[4]Kalin R,Stanton MS.Current clinical issues for MRI scanning of pacemaker and defibrillator patients[J].Pacing Clin Electrophysiol,2005,28(4):326-328.
[5]刘兴鹏,田颖,任明,等.我国接受心血管植入型电子器械治疗的老年患者磁共振检查的需求调查[J].中华心律失常学杂志,2015,19(4):268-270.
[6]Higgins JV,Sheldon SH,Watson RE Jr,et al.“Power-on resets”in cardiac implantable electronic devices during magnetic resonance imaging[J].Heart Rhythm,2015,12(3):540-544.
[7]Sommer T,Naehle CP,Yang A,et al.Strategy for safe performance of extrathoracic magnetic resonance imaging at 1.5 tesla in the presence of cardiac pacemakers in non-pacemaker-dependent patients:a prospective study with 115 examinations[J].Circulation,2006,114(12):1285-1292.
[8]Wollmann CG,Thudt K,Kaiser B,et al.Safe performance of magnetic resonance of the heart in patients with magnetic resonance conditional pacemaker systems:the safety issue of the ESTIMATEstudy[J].J Cardiovasc Magn Reson,2014,16:30.
[9]Bailey WM,Mazur A,Mc Cotter C,et al.Clinical safety of the Pro MRI pacemaker system in patients subjected to thoracic spine and cardiac 1.5-T magnetic resonance imaging scanning conditions[J].Heart Rhythm,2016,13(2):464-471.
[10]Yazaki K,Watarai M,Kahata M,et al.Cause of the“power-on reset”phenomenon other than electric magnetic interference in a patient with a pacemaker[J].Indian Pacing Electrophysiol J,2018,18(4):150-151.
[11]吴冬燕,卢凤民,李琼,等.磁共振兼容起搏器的临床应用评价[J].中华心律失常学杂志,2017,21(2):103-106.
[12]Williamson BD,Gohn DC,Ramza BM,et al.Real-World evaluation of magnetic resonance imaging in patients with a magnetic resonance imaging conditional pacemaker system:results of 4-year prospective follow-up in 2,629 patients[J].JACC Clin Electrophysiol,2017,3(11):1231-1239.