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Safety of cardiovascular magnetic resonance in patients with cardiovascular implants and devices
  1. S K Prasad,
  2. D J Pennell
  1. Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Professor Dudley J Pennell
    Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;

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Cardiovascular magnetic resonance is very safe, but occasional serious complications may occur in patients with some implants or devices. Pacemakers currently present the largest problem, but new research shows that the perceived dangers have been overestimated and in particular new lead solutions are emerging. Common implants that may be scanned safely include sternal and epicardial wires, prosthetic valves, and stents.

Cardiovascular magnetic resonance (CMR) is a new and important tool for the evaluation of patients with cardiovascular disease. Because of relative unfamiliarity, some cardiologists may not be fully conversant with safety issues associated with this technique in patients with cardiovascular implants and devices. The aim of this article is to summarise where the problems are and what solutions are available or forthcoming. In some areas, we will also dispel myths which are sometimes held in the absence of any actual evidence and present a common sense approach which has been adopted by expert centres in clinical practice using 1.5 Tesla (T) scanners.

The basic principle of MR relies upon the application of radiofrequency pulses (RF) within a strong magnetic field. Hydrogen nuclei absorb the RF, and re-emit it after a short delay as a detectable signal which can be converted into images. Because there are no x rays, there are no known genetic effects or changes in chemical binding. Thus CMR shares with ultrasound an inherent safety advantage over x ray techniques. However, unlike either ultrasound or x ray techniques, there is interaction of the magnetic field with ferromagnetic materials (potential for movement) and electronic circuits (dysfunction or damage), and the RF may produce heating under certain limited circumstances.1 These phenomena require special attention for CMR.



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