Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2015 | Research

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Authors: Oliver Klein-Wiele, Marietta Garmer, Rhyan Urbien, Martin Busch, Kaffer Kara, Serban Mateiescu, Dietrich Grönemeyer, Michael Schulte-Hermes, Marc Garbrecht, Birgit Hailer

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2015

Abstract

Background

Cardiovascular Magnetic Resonance (CMR) with adenosine stress is a valuable diagnostic tool in coronary artery disease (CAD). However, despite the development of MR conditional pacemakers CMR is not yet established in clinical routine for pacemaker patients with known or suspected CAD. A possible reason is that adenosine stress perfusion for ischemia detection in CMR has not been studied in patients with cardiac conduction disease requiring pacemaker therapy. Other than under resting conditions it is unclear whether MR safe pacing modes (paused pacing or asynchronous mode) can be applied safely because the effect of adenosine on heart rate is not precisely known in this entity of patients. We investigate for the first time feasibility and safety of adenosine stress CMR in pacemaker patients in clinical routine and evaluate a pacing protocol that considers heart rate changes under adenosine.

Methods

We retrospectively analyzed CMR scans of 24 consecutive patients with MR conditional pacemakers (mean age 72.1 ± 11.0 years) who underwent CMR in clinical routine for the evaluation of known or suspected CAD. MR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement.

Results

Pacemaker indications were sinus node dysfunction (n = 18) and second or third degree AV block (n = 6). Under a pacing protocol intended to avoid competitive pacing on the one hand and bradycardia due to AV block on the other no arrhythmia occurred. Pacemaker stimulation was paused to prevent competitive pacing in sinus node dysfunction with resting heart rate >45 bpm. Sympatho-excitatory effect of adenosine led to a significant acceleration of heart rate by 12.3 ± 8.3 bpm (p < 0.001), no bradycardia occurred. On the contrary in AV block heart rate remained constant; asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm.

Conclusion

Adenosine stress CMR appears to be feasible and safe in patients with MR conditional pacemakers. Heart rate response to adenosine has to be considered for the choice of pacing modes during CMR.

American College of Cardiology Foundation Task Force on Expert Consensus D, Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, et al. al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American college of cardiology foundation task force on expert consensus documents. J Am Coll Cardiol. 2010;55:2614–62.CrossRef

Gargiulo P, Dellegrottaglie S, Bruzzese D, Savarese G, Scala O, Ruggiero D, et al. The prognostic value of normal stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a meta-analysis. Circ Cardiovasc Imaging. 2013;6:574–82.PubMedCrossRef

Authors/Task Force m, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS)developed with the special contribution of the European association of percutaneous cardiovascular interventions (EAPCI). Eur Heart J. 2014;35:2541–619.CrossRef

Hundley WG, Hamilton CA, Thomas MS, Herrington DM, Salido TB, Kitzman DW, et al. Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography. Circulation. 1999;100:1697–702.PubMedCrossRef

Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM. Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation. 2001;104:1101–7.PubMedCrossRef

Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2007;50:1343–53.PubMedCrossRef

Li M, Zhou T, Yang LF, Peng ZH, Ding J, Sun G. Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis. JACC Cardiovasc Imaging. 2014;7:1098–105.PubMedCrossRef

Alonso A, Jensen PN, Lopez FL, Chen LY, Psaty BM, Folsom AR, et al. Association of sick sinus syndrome with incident cardiovascular disease and mortality: the atherosclerosis risk in communities study and cardiovascular health study. PLoS One. 2014;9, e109662.PubMedCentralPubMedCrossRef

Hsueh CW, Lee WL, Chen YT, Ting CT. The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias. Jpn Heart J. 2001;42:417–23.PubMedCrossRef

10.

Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005;32:855–97.PubMedCrossRef

11.

Ewy GA. Sick sinus syndrome: synopsis. J Am Coll Cardiol. 2014;64:539–40.PubMedCrossRef

12.

Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia’s project. Pacing Clin Electrophysiol. 2011;34:1013–27.PubMedCrossRef

13.

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European society of cardiology (ESC). developed in collaboration with the European heart rhythm association (EHRA). Eur Heart J. 2013;34:2281–329.PubMedCrossRef

14.

Stanton MS. Industry viewpoint: medtronic: pacemakers, ICDs, and MRI. Pacing Clin Electrophysiol. 2005;28:265.PubMedCrossRef

15.

Nazarian S, Roguin A, Zviman MM, Lardo ACN, Dickfeld TL, Calkins H, et al. Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable-cardioverter defibrillators at 1.5 tesla. Circulation. 2006;114:1277–84.PubMedCentralPubMedCrossRef

16.

Friedman HL, Acker N, Dalzell C, Shen WK, Asirvatham SJ, Cha YM, et al. Magnetic resonance imaging in patients with recently implanted pacemakers. Pacing Clin Electrophysiol. 2013;36:1090–5.PubMedCrossRef

17.

Buendia F, Cano O, Sanchez-Gomez JM, Igual B, Osca J, Sancho-Tello MJ, et al. Cardiac magnetic resonance imaging at 1.5 T in patients with cardiac rhythm devices. Europace. 2011;13:533–8.PubMedCrossRef

18.

Naehle CP, Kreuz J, Strach K, Schwab JO, Pingel S, Luechinger R, et al. Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T. Am Heart J. 2011;161:1096–105.PubMedCrossRef

19.

Sasaki T, Hansford R, Zviman MM, Kolandaivelu A, Bluemke DA, Berger RD, et al. Quantitative assessment of artifacts on cardiac magnetic resonance imaging of patients with pacemakers and implantable cardioverter-defibrillators. Circ Cardiovasc Imaging. 2011;4:662–70.PubMedCentralPubMedCrossRef

20.

Nazarian S, Beinart R, Halperin HR. Magnetic resonance imaging and implantable devices. Circ Arrhythm Electrophysiol. 2013;6:419–28.PubMedCrossRef

21.

Wollmann CG, Thudt K, Kaiser B, Salomonowitz E, Mayr H, Globits S. Safe performance of magnetic resonance of the heart in patients with magnetic resonance conditional pacemaker systems: the safety issue of the ESTIMATE study. J Cardiovasc Magn Reson. 2014;16:30.PubMedCentralPubMedCrossRef

22.

Gimbel JR, Bello D, Schmitt M, Merkely B, Schwitter J, Hayes DL, et al. Randomized trial of pacemaker and lead system for safe scanning at 1.5 Tesla. Heart Rhythm. 2013;10:685–91.PubMedCrossRef

23.

Schwitter J, Kanal E, Schmitt M, Anselme F, Albert T, Hayes DL, et al. Impact of the Advisa MRI pacing system on the diagnostic quality of cardiac MR images and contraction patterns of cardiac muscle during scans: Advisa MRI randomized clinical multicenter study results. Heart Rhythm. 2013;10:864–72.PubMedCrossRef

24.

Hogarth AJ, Artis NJ, Sivananthan UM, Pepper CB. Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker. Heart Int. 2011;6, e19.PubMedCentralPubMedCrossRef

25.

Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Luderitz B, Reynolds DW, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol. 2002;25:260–4.PubMedCrossRef

26.

Biaggioni I, Killian TJ, Mosqueda-Garcia R, Robertson RM, Robertson D. Adenosine increases sympathetic nerve traffic in humans. Circulation. 1991;83:1668–75.PubMedCrossRef

27.

Sweeney MO, Porkolab FL. Ventricular fibrillation induced by double premature ventricular pacing stimuli in a dual-chamber pacemaker with AutoCapture. Heart Rhythm. 2009;6:429–32.PubMedCrossRef

28.

Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.CrossRef

29.

Nowak B, Hemmer W, Israel CW, Kramer LI, Neuzner J, Pfeiffer D, et al. Statement of the working group of the Germany society on the safety of asynchronous ventricular pacemaker stimulation. Clin Res Cardiol. 2006;95:57–60.PubMedCrossRef

30.

Brignole M, Menozzi C, Alboni P, Oddone D, Gianfranchi L, Gaggioli G, et al. The effect of exogenous adenosine in patients with neurally-mediated syncope and sick sinus syndrome. Pacing Clin Electrophysiol. 1994;17:2211–6.PubMedCrossRef

31.

Fragakis N, Antoniadis AP, Korantzopoulos P, Kyriakou P, Koskinas KC, Geleris P. Sinus nodal response to adenosine relates to the severity of sinus node dysfunction. Europace. 2012;14:859–64.PubMedCrossRef

32.

Biaggioni I, Olafsson B, Robertson RM, Hollister AS, Robertson D. Cardiovascular and respiratory effects of adenosine in conscious man. Evidence for chemoreceptor activation. Circ Res. 1987;61:779–86.PubMedCrossRef

33.

Costa F, Biaggioni I. Adenosine activates afferent fibers in the forearm, producing sympathetic stimulation in humans. J Pharmacol Exp Ther. 1993;267:1369–74.PubMed

34.

Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol. 2009;54:764–76.PubMedCrossRef

35.

DiMarco JP, Sellers TD, Berne RM, West GA, Belardinelli L. Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation. 1983;68:1254–63.PubMedCrossRef

36.

Makaryus JN, Catanzaro JN, Friedman ML, Katona KC, Makaryus AN. Persistent second-degree atrioventricular block following adenosine infusion for nuclear stress testing. J Cardiovasc Med (Hagerstown). 2008;9:304–7.CrossRef

37.

Mallet ML. Proarrhythmic effects of adenosine: a review of the literature. Emerg Med J. 2004;21:408–10.PubMedCentralPubMedCrossRef

38.

Ricci DR, Rider AK, Mason JW. Recurrent tachyarrhythmia associated with a bifocal demand pacemaker. Chest. 1977;72:120–3.PubMedCrossRef

39.

Zimmerman SL, Nazarian S. Cardiac MRI in the treatment of arrhythmias. Expert Rev Cardiovasc Ther. 2013;11:843–51.PubMedCrossRef

40.

Headrick JP, Peart JN, Reichelt ME, Haseler LJ. Adenosine and its receptors in the heart: regulation, retaliation and adaptation. Biochim Biophys Acta. 1808;2011:1413–28.

41.

Manisty C, Ripley DP, Herrey AS, Captur G, Wong TC, Petersen SE, et al. Splenic switch-off: a tool to assess stress adequacy in adenosine perfusion cardiac MR imaging. Radiology. 2015;276:732–40.PubMedCrossRef

42.

Lapeyre 3rd AC, Poornima IG, Miller TD, Hodge DO, Christian TF, Gibbons RJ. The prognostic value of pharmacologic stress myocardial perfusion imaging in patients with permanent pacemakers. J Nucl Cardiol. 2005;12:37–42.PubMedCrossRef

43.

Naehle CP, Zeijlemaker V, Thomas D, Meyer C, Strach K, Fimmers R, et al. Evaluation of cumulative effects of MR imaging on pacemaker systems at 1.5 Tesla. Pacing Clin Electrophysiol. 2009;32:1526–35.PubMedCrossRef

44.

Vahlhaus C, Sommer T, Lewalter T, Schimpf R, Schumacher B, Jung W, et al. Interference with cardiac pacemakers by magnetic resonance imaging: are there irreversible changes at 0.5 Tesla? Pacing Clin Electrophysiol. 2001;24:489–95.PubMedCrossRef

Title: Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla
Authors: Oliver Klein-Wiele
Marietta Garmer
Rhyan Urbien
Martin Busch
Kaffer Kara
Serban Mateiescu
Dietrich Grönemeyer
Michael Schulte-Hermes
Marc Garbrecht
Birgit Hailer
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2015
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-015-0218-x

At a glance: The STEP trials

Springer Medicine

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Validation of high temporal resolution spiral phase velocity mapping of temporal patterns of left and right coronary artery blood flow against Doppler guidewire

Cardiovascular Magnetic Resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease

Parallel simulations for QUAntifying RElaxation magnetic resonance constants (SQUAREMR): an example towards accurate MOLLI T1 measurements

Review of Journal of Cardiovascular Magnetic Resonance 2014

Characterization of myocardial T1-mapping bias caused by intramyocardial fat in inversion recovery and saturation recovery techniques

Systolic ShMOLLI myocardial T1-mapping for improved robustness to partial-volume effects and applications in tachyarrhythmias