起搏器患者进行磁共振检查的安全性研究

Safety assessment for magnetic resonance imaging in patients with pacemakers

目的:调查植入磁共振(MR)条件兼容起搏器的患者进行MR检查的即刻和长期安全性。方法:回顾2011—2019年在我院植入MR兼容起搏器的患者287例,随访器械相关的主要安全性终点(电量提前耗竭,导线功能异常或起搏失夺获)和临床安全性主要终点(死亡,心脏停搏>5 s,持续性室性心律失常)的发生。比较MR检查前后参数变化,及与对照人群基线和长期起搏参数的改变。结果:所有患者在随访中均无临床终点事件和器械相关功能异常发生。共11例患者接受了MR检查,扫描部位为头颅(9例),腰椎(1例),颌面部(1例),中位扫描时间20(10~34) min。MR后即刻、MR后1~3个月患者起搏参数及电池电压较MR前无显著改变。进行MR与未进行MR的患者基线和慢性期起搏参数、电池电压无显著差异(均P>0.05)。结论:植入MR兼容起搏器患者严格按照流程进行MR前准备和程控,可以安全进行推荐场强和部位的MR检查。

Objective: To determine the safety in patients with MR-conditional device to undergo MR imaging. Method: Study cohort was established including 287 patients with MR-conditional pacemakers implantation in our center between 2011 and 2019. Primary device-related endpoints(premature exhaustion of the battery, malfunction of the leads or loss of capture) and clinical endpoints(death, cardiac arrest>5 seconds, and the occurrence of sustained ventricular arrhythmias) were collected during follow-up. On interrogation, post-MR results of the device parameters were compared with reference to the data prior to the MR, as well as to patients who did not undergo MR examination. Result: No clinical or device related events occured during the MR examination and during follow up. A total of 11 patients received MR examination, including 9 cases of skull imaging, 1 case of lumbar imaging and 1 case of maxillofacial imaging with the median scanning time of 20(10-34) minutes. Pacing parameters and battery voltage showed no significant changes in before and after MR. No changes of pacemaker function were observed between the patients undergoing MR and control(all P>0.05). Conclusion: With adherence to a standardized protocol for MR imaging preparation and programming, MR with certain field intensity and locations could safely be performed in patients with MR-conditional pacemakers.