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DOI: 10.1055/s-2008-1067294
© Georg Thieme Verlag KG Stuttgart · New York
Sicherheit von Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren im Magnetresonanztomographen
Beurteilung der Aggregatfunktion bei 1,5 TeslaSafety of cardiac pacemakers and ICDs in magnetic resonance imagingPublikationsverlauf
eingereicht: 22.1.2008
akzeptiert: 6.3.2008
Publikationsdatum:
19. März 2008 (online)
![](https://www.thieme-connect.de/media/dmw/200813/lookinside/thumbnails/10.1055-s-2008-1067294-1.jpg)
Zusammenfassung
Hintergrund und Fragestellung: Die Magnetresonanztomographie (MRT) findet im klinischen Alltag zunehmend Verbreitung, ist aber für Träger von Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren (ICDs) kontraindiziert. In dieser Studie wurde näher untersucht, unter welchen Umständen im MRT potentiell lebensbedrohliche Arrhythmien ausgelöst werden können und ob diesem Problem durch Programmierung des Aggregats begegnet werden kann.
Methodik: Acht Schrittmacher und sieben ICDs wurden mit verschiedenen Programmierungen im Phantom bei 1,5 Tesla (Experimental- und Bildgebungs-Sequenzen) getestet.
Ergebnisse: Bei vier Schrittmachern kam es zum Abfall der Batteriespannung (Austauschindikation), bei drei davon zusätzlich zu Änderungen in der Programmierung (Reset). Bei den getesteten ICDs traten solche Veränderungen nicht auf, jedoch wurden abhängig von den verwendeten Pulssequenzen bei allen Modellen tachykarde Episoden während der MRT angezeigt.
Folgerung: Die elektromagnetischen Felder im MRT sind bereits unter klinischen Routinebedingungen in der Lage, schwere Funktionsstörungen bei Herzschrittmachern zu verursachen. Bestimmte Aggregat-Programmierungen sind nur bedingt geeignet, die Patienten-Sicherheit im MRT zu erhöhen, da stets mit Verlust beziehungsweise unvorhersehbaren Änderungen der Programmierung gerechnet werden muss.
Summary
Background and objective: Magnetic resonance imaging (MRI) is increasingly used in patients, but it is contraindicated in those with cardiac pacemakers (CP) or implantable cardioverter defibrillators (ICD). This study examined circumstances in which potentially life-threatening arrhythmias may be triggered in patients with CP undergoing MRI and whether these problems can be avoided by reprogramming of these devices.
Methods: Eight CP and seven ICDs were investigated in a phantom at 1.5 tesla (experimental and imaging sequences).
Results: A decrease in battery voltage was found in four CP after MRI (indication for elective replacement). Additionally, three showed changes in programming (resets). Analogous changes did not appear in the tested ICDs, but periods of tachycardia were recorded in all types of devices during MRI depending on the pulse sequence employed.
Conclusion: MRI-related electromagnetic fields as used in routine MRI can induce severe pacemaker device malfunctions. Device programming approaches are unreliable for prevention of patient hazards, as programming changes or resets are one of the primary malfunctions during MRI.
Schlüsselwörter
Herzschrittmacher - Aggregatfunktion - Magnetresonanztomographen - implantierbare Kardioverter-Defibrillatoren
Key words
magnetic field effects - cardiac pacemaker functioning - magnetic resonance imaging - implantable cardioverter defibrillator
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Dr. Peter Nordbeck
Medizinische Klinik und Poliklinik I der Universität Würzburg
Josef-Schneider-Str. 2
97080 Würzburg
Telefon: + 49/931/888-5157
Fax: + 49/931/888-5851
eMail: nordbeck@physik.uni-wuerzburg.de