"power-on resets" in cardiac implantable electronic devices during magnetic resonance imaging

John V. Higgins, Seth H. Sheldon, Robert E. Watson, Connie Dalzell, Nancy Acker, Yong Mei Cha, Samuel J. Asirvatham, Suraj Kapa, Joel P. Felmlee, Paul A. Friedman

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Background Magnetic resonance imaging (MRI) has been safely performed in some patients with cardiac implantable electronic devices (CIEDs) under careful monitoring and prespecified conditions. Pacemaker-dependent patients are often excluded, partly because of the potential for "power-on reset" (PoR), which can lead to a change from asynchronous to inhibited pacing with consequent inhibition of pacing due to electromagnetic interference during MRI. Objective The purpose of this study was to review risk factors for PoR during MRI. Methods A prospective study was performed between January 2008 and May 2013 in patients with CIEDs undergoing clinically indicated MRI. Eligible patients were not pacemaker dependent. Devices were interrogated before and after MRI, programmed to an asynchronous mode or an inhibition mode with tachyarrhythmia therapies turned off, and reprogrammed to their original settings after MRI. Results MRI scans (n = 256) were performed in 198 patients with non-MRI-conditional CIEDs between 2008 and 2013 (median age 66 years; interquartile range 57-77 years; 59% men). PoR occurred during 9 MRI scans (3.5%) in 8 patients. PoR was more frequent with Medtronic devices than with other generator brands (n = 9/139 vs 0/117 [6% vs 0%]; P =.005). Devices with PoR were all released before 2002 and were implanted from 1999 to 2004. Effects of PoR included a decrease in heart rate during MRI (n = 4) and transient anomalous battery life indication (n = 1). All devices functioned normally after MRI. Conclusion PoR occurs infrequently but can cause deleterious changes in pacing mode and heart rate. MRI should not be performed in pacemaker-dependent patients with older at-risk generators. Continuous monitoring during MRI is essential because unrecognized PoR may inhibit pacing or accelerate battery depletion due to high pacing output.

Original languageEnglish (US)
Pages (from-to)540-544
Number of pages5
JournalHeart rhythm
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2015

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Keywords

  • Cardiac implantable electronic device
  • Magnetic resonance imaging
  • Pacemaker safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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