Author + information
- Received July 8, 2017
- Accepted July 20, 2017
- Published online January 15, 2018.
- Susanne Löbe, MD∗ (, )
- Sebastian Hilbert, MD,
- Gerhard Hindricks, MD,
- Cosima Jahnke, MD and
- Ingo Paetsch, MD
- ↵∗Address for correspondence:
Dr. Susanne Löbe, Department of Rhythmology, HELIOS Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
A 69-year-old man with suspected myocarditis was referred for cardiovascular magnetic resonance (CMR) imaging. The patient had undergone a leadless cardiac pacemaker implantation (Nanostim, St. Jude Medical, St. Paul, Minnesota) (Figure 1A) 20 months before because of symptomatic sick sinus syndrome. Device interrogation was done directly before and after CMR imaging (1) and the device was programmed to OVO during the CMR examination (intrinsic heart rate, 65/min). CMR was performed on a 1.5-T magnetic resonance system with specific absorption rate limited to <2.0 W/kg body weight; vector-electrocardiogram, noninvasive blood pressure, and pulse oximetry were continuously monitored. On steady-state free precession cine imaging, image quality was degraded by device-related susceptibility and off-resonance artifacts at implantation site (apicoseptal region of the heart) (Figure 1B, Online Video 1). Image quality considerably improved when using native turbo-field echo cine sequences (Figure 1C, Online Video 1) with an even further increase in endocardial border delineation/device conspicuity following contrast agent application Figures 1D and 1E, Online Video 1). First-pass perfusion (Figure 1H) and T1-/T2-weighted blackblood imaging (Figures 1F and 1G) demonstrated negligible device-related artifacts at the right-ventricular apex with unimpaired image quality of left-ventricular segments. Late-gadolinium enhancement was artifact-free with regard to left-ventricular segments but the right-ventricular apical segment could not be discerned (Figure 1I). No changes in functional pacemaker parameters (i.e., battery status/pacing threshold/amplitude of the intracardiac signal/lead impedance) were noted after the CMR examination. Thus, the entire spectrum of routine CMR imaging sequences can be used in the presence of the Nanostim leadless pacemaker resulting in no or only minimal image quality impairment restricted to the implantation site only.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 8, 2017.
- Accepted July 20, 2017.
- 2018 American College of Cardiology Foundation