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

Journal of Cardiovascular Magnetic Resonance

Research

Kaffer Kara¹  Marietta Garmer²  Dietrich Grönemeyer²  Serban Mateiescu²  Martin Busch²  Oliver Klein-Wiele³  Birgit Hailer³  Rhyan Urbien³  Marc Garbrecht³  Michael Schulte-Hermes⁴ 

[1] Cardiovascular Centre, Josef Hospital, University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany;Department of Radiology, Grönemeyer Institut Bochum, University of Witten/Herdecke, Universitätsstraße 142, 44799, Bochum, Germany;Deptartment of Cardiology, Katholisches Klinikum Essen, University of Witten/Herdecke, Hülsmannstraße 17, 45355, Essen, Germany;Deptartment 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;

关键词: Pacemaker;    MR conditional;    Cardiovascular magnetic resonance;    Adenosine stress;    Safety;    Sinus node dysfunction;    Atrioventricular block;    MR safe pacing modes;    Asynchronous pacing;   

DOI  :  10.1186/s12968-015-0218-x

 received in 2015-09-20, accepted in 2015-12-09,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCardiovascular 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.MethodsWe 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.ResultsPacemaker 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.ConclusionAdenosine 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.

【 授权许可】

CC BY   
© Klein-Wiele et al. 2015