Objectives
To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD).
Methods
We prospectively compared ...cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG).
Results
142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three–12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic.
Conclusions
A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported.
Key points
• Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers.
• No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers.
• Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic.
• All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic.
• Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.
Catheter ablation (CA) of left atrial tachycardia adjacent to implanted septal closure devices represents a multifaceted challenge. We describe the case of a 57-year-old patient with remote ...percutaneous closure of atrial septal defect who underwent successful CA of left atrial tachycardia adjacent to the septal device using a transaortic approach and RF energy. Besides the technical difficulties and associated risks, interference between the device and applied RF parameters may limit ablation efficiency. Further research is required to evaluate the safety, efficacy, and optimal energy type/parameters when ablating arrhythmias adjacent to these devices.
Purpose
In patients with cancer, the safety of catheter ablation for non-valvular atrial fibrillation (AF) has not been evaluated, yet. The aim of this study was to assess the safety of AF ablation ...in cancer survivors.
Methods
Consecutively recruited patients undergoing catheter ablation of non-valvular AF at our center between March 2015 and March 2017 were evaluated. The primary outcome of the study was clinically relevant bleedings occurred within 30 ± 5 days after the procedure. Patients with cancer were propensity matched to patients without cancer in a 1:3 and 1:6 ratio after stratification by baseline clinical features.
Results
Overall, 184 patients were included in the study. Of them, 21 (11%) were cancer survivors. Cancer site was more frequently gastrointestinal (36%), breast (23%), and genitourinary (18%). At 30 ± 5 days, clinically relevant bleedings occurred in 14 patients. Crude odds ratio (OR) for clinically relevant bleedings was 3.60 (95% CI 1.02–12.7) higher in cancer than in non-cancer patients. This trend remained after propensity score–matched population (OR 3.48, 95% CI 0.76–15.90 for matched 1:3, OR 4.95, 95% CI 1.2–20.2 for matched 1:6). Type of anticoagulation was not associated with bleedings.
Conclusions
Preliminary results suggest that clinically relevant bleeding after catheter ablation for AF is more frequent in cancer survivors than in patients without cancer. Further studies are required to confirm the present data.
This case concerns a 24‐year‐old female who developed malignant ventricular tachyarrhythmia a few weeks after pacemaker implantation for complete heart block. Apparently, right ventricular pacing ...caused significant repolarization abnormalities in both native and paced rhythms with marked QT prolongation and substantial electrical instability. This case highlights other intriguing phenomena in the puzzle of cardiac repolarization and how pacing therapy may alter this complex process providing arrhythmic substrate in vulnerable subjects. Though such arrhythmic events are clinically rare, vulnerable patients or with suspected myocardial disease that may cause QT prolongation should be carefully followed in the course of pacing therapy.
PDF