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MRI scan safe in ICD patients, provided precautions are taken

Bonn, Germany - Patients with a non-pacemaker-dependent implantable cardioverter defibrillator (ICD) can safely undergo an MRI scan provided certain precautions are taken, according to the results of a new study [1].

Utilizing the various ICD, MRI, and monitoring-related safety precautions, investigators did not observe any damage to the ICD systems or any unexpected changes in heart rate or rhythm. Also, there were no inappropriate shocks delivered and no evidence of radiofrequency-related myocardial thermal damage during or after the scan.

"The number of implanted pacemakers and ICDs, as well as the number of devices for cardiac resynchronization therapy, are going up every year," said lead investigator Dr Claas Philip Naehle (University of Bonn, Germany). "People are getting older, and the older they get, the greater the likelihood they're going to need an MRI exam. Obviously that's a big overlap, and it's why we're seeing a lot of patients referred to us for an MRI exam."

The results of the study are published in the August 4, 2009 issue of the Journal of the American College of Cardiology

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Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia

Rahul Jain, MD; Darshan Dalal, MD; Amy Daly, MS; Crystal Tichnell, MGC; Cynthia James, PhD; Ariana Evenson, MHSA; Rohit Jain, MD; Theodore Abraham, MD; Boon Yew Tan, MBChB; Hari Tandri, MD; Stuart D. Russell, MD; Daniel Judge, MD; Hugh Calkins, MD

From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to Hugh Calkins, MD, Carnegie 530, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21287. E-mail hcalkins@jhmi.edu

Received December 1, 2008; accepted June 1, 2009.

Background— The purpose of this study was to reevaluate the ECG features of arrhythmogenic right ventricular dysplasia (ARVD). The second objective was to evaluate the sensitivity and specificity of the standard and newly proposed diagnostic ECG markers in the presence of a right bundle-branch block (RBBB).

Methods and Results— One hundred patients with ARVD (57 men; aged 39±15 years) and 57 controls (21 men; aged 40±17 years) were included. Among the 100 patients with ARVD, a complete RBBB was present in 17 patients, and 15 patients had an incomplete RBBB. T-wave inversion through V3 demonstrated optimal sensitivity and specificity in both ARVD patients without a complete RBBB or incomplete RBBB (71% [95% confidence interval, 58% to 81%] and 96% [95% confidence interval, 81% to 100%], respectively) and in ARVD patients with incomplete RBBB (73% [95% confidence interval, 45% to 92%] and 95% [95% confidence interval, 77% to 100%], respectively). Between ARVD patients and controls with a complete RBBB, the only 2 parameters that differed were the prevalence of T-wave inversion through V4 (59% versus 12%, respectively; P<0.05) and an r'/s ratio in V1 <1 (88% versus 14%, respectively; P<0.005). In ARVD patients with complete RBBB, the most sensitive and specific parameter was an r'/s ratio <1.

Conclusions— We evaluated comprehensively the diagnostic value of ECG markers for ARVD. On the basis of the findings, we propose an algorithm, with examination of QRS morphology being the first step, for ECG evaluation of ARVD patients. Definite criteria are then applied on the basis of the presence of no RBBB, incomplete RBBB, and complete RBBB to obtain the best diagnostic utility of the ECG.

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"Worrisome" radiation doses with imaging, new study finds : Aug 28 2009 

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