Deactivation vs. asynchronous pacing - prospective evaluation of a protocol for rhythm management in patients with magnetic resonance conditional pacemakers undergoing adenosine stress cardiovascular magnetic resonance imaging

BMC Cardiovascular Disorders

Research Article

Kaffer Kara¹  Oliver Klein-Wiele²  Gianluca Barbone²  Birgit Hailer²  Rhyan Urbien²  Harald Schäfer²  Michael Schulte-Hermes³  Marietta Garmer⁴  Dietrich Grönemeyer⁴  Martin Busch⁴ 

[1] Cardiovascular Center, Josef Hospital, University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany;Department of Cardiology, Katholisches Klinikum Essen, University of Witten/Herdecke, Hülsmannstraße 17, 45355, Essen, Germany;Department of Cardiology, Katholisches Klinikum Essen, University of Witten/Herdecke, Hülsmannstraße 17, 45355, Essen, Germany;Department of Cardiology, Prosper-Hospital Recklinghausen, University of Witten/Herdecke, Mühlenstraße 27, 45659, Recklinghausen, Germany;Department of Radiology, Grönemeyer Institut Bochum, University of Witten/Herdecke, Universitätsstraße 142, 44799, Bochum, Germany;

关键词: Pacemaker;    MRI conditional;    Cardiovascular magnetic resonance;    CMR;    Adenosine stress;    Safety;    Sinus node dysfunction;    Atrioventricular block;    Asynchronous pacing;   

DOI  :  10.1186/s12872-017-0579-1

 received in 2017-02-09, accepted in 2017-05-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCardiovascular Magnetic Resonance (CMR) imaging with adenosine stress is an important diagnostic tool in patients with known or suspected coronary artery disease (CAD). However, the method is not yet established for CAD patients with pacemakers (PM) in clinical practice. A possible reason is that no recommendations exist for PM setting (paused pacing or asynchronous mode) during adenosine stress. We elaborated a protocol for rhythm management in clinical routine for PM patients that considers heart rate changes under adenosine using a test infusion of adenosine in selected patients.Methods47 consecutive patients (mean age 72.3 ± 10,0 years) with MR conditional PM and known or suspected CAD who underwent CMR in clinical routine were studied in this prospective observational study. PM indications were sinus node dysfunction (SND, n = 19; 40,4%), atrioventricular (AV) block (n = 26; 55.3%) and bradyarrhythmia in permanent atrial fibrillation (AF, n = 2; 4.3%). In patients with SND, normal AV-conduction and resting HR >45 bpm at the time of CMR and in AF the PM was deactivated for the scan. In intermittent AV-block a test infusion of adenosine was given prior to the scan. All patients with permanent higher degree sinuatrial or AV-block or deterioration of AV-conduction in the adenosine test were paced asynchronously during CMR, in patients with preserved AV-conduction under adenosine the pacemaker was deactivated. CMR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement.ResultsThe adenosine test was able to differentiate between mandatory PM stimulation during CMR and safe deactivation of the device. In patients with permanent sinuatrial or AV-block (n = 11; 23.4%) or deterioration of AV conduction in the adenosine test (n = 5, 10.6%) asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm, no competitive stimulation was seen during the scan. 10 of 15 (66,7%) patients with intermittent AV-block showed preserved AV-conduction under adenosine. As in SND and AF deactivation of the PM showed to be safe during CMR, no bradycardia was observed.ConclusionOur protocol for rhythm management during adenosine stress CMR showed to be feasible and safe and may be recommended for pacemaker patients undergoing routine CMR.

【 授权许可】

CC BY   
© The Author(s). 2017