Key result
3 Tesla cardiovascular magnetic resonance imaging resulted in a significantly higher artefact burden of grade 3 and 4 artefacts compared to 1.5 Tesla imaging in patients with leadless cardiac pacemakers (3.7 vs 1.9 affected segments per patient, p=0.03).
Why the study?
Does 3 Tesla CMR imaging compared to 1.5 Tesla CMR imaging increase artefact burden in patients with leadless cardiac pacemakers?
RCT (n=15)
1:1
No
Does 3 Tesla CMR imaging compared to 1.5 Tesla CMR imaging increase artefact burden in patients with leadless cardiac pacemakers?
Absolute Event Rate: 3.7% vs 1.9%
p-value: p=0.03
CMR imaging is feasible and safe in patients with leadless cardiac pacemakers, but 1.5 Tesla scanners are preferred over 3 Tesla scanners to minimize imaging artefacts.
1.5T CMR preferred over 3T to minimize artefacts in leadless pacemaker patients; provides RCT evidence guiding field-strength selection.
BACKGROUND: There are limited data on patients with leadless cardiac pacemakers (LCP) undergoing magnetic resonance imaging. The aim of this prospective, single-center, observational study was to evaluate artefacts on cardiovascular magnetic resonance (CMR) images in patients with LCP. METHODS: Fifteen patients with Micra™ LCP, implanted at least 6 weeks prior to CMR scan, were enrolled and underwent either 1.5 Tesla or 3 Tesla CMR imaging. Artefacts were categorized into grade 1 (excellent image quality), grade 2 (good), grade 3 (poor) and grade 4 (non-diagnostic) for each myocardial segment. One patient was excluded because of an incomplete CMR investigation due to claustrophobia. RESULTS: ) at the right ventricular (RV) apex. Of 224 analyzed myocardial segments of the left ventricle (LV) 158 (70.5%) were affected by grade 1, 27 (12.1%) by grade 2, 17 (7.6%) by grade 3 and 22 (9.8%) by grade 4 artefacts. The artefact burden of grade 3 and 4 artefacts was significantly higher in the 3 Tesla group (3 Tesla vs 1.5 Tesla: 3.7 ± 1.6 vs 1.9 ± 1.4 myocardial segments per patient, p = 0.03). A high artefact burden was particularly observed in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV and in the mid and apical segments of the RV. Quantification of LV function and assessment of valves were feasible in all patients. We did not observe any clinical or device-related adverse events. CONCLUSION: CMR imaging in patients with LCP is feasible with excellent to good image quality in the majority of LV segments. The artefact burden is comparable small allowing an accurate evaluation of LV function, cardiac structures and valves. However, artefacts in the mid anteroseptal, inferoseptal and apical septal myocardial segments of the LV due to the LCP may impair or even exclude diagnostic evaluation of these segments. Artefacts on CMR images may be reduced by the use of 1.5 Tesla CMR scanners.
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Kiblboeck et al. (2018) conducted an RCT in Leadless cardiac pacemakers (n=15). 3 Tesla CMR imaging vs. 1.5 Tesla CMR imaging was evaluated on Artefact burden of grade 3 and 4 artefacts (affected myocardial segments per patient) (p=0.03). 3 Tesla cardiovascular magnetic resonance imaging resulted in a significantly higher artefact burden of grade 3 and 4 artefacts compared to 1.5 Tesla imaging in patients with leadless cardiac pacemakers (3.7 vs 1.9 affected segments per patient, p=0.03).
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