Download cardiac mri: follow-up after an alcohol septal

CARDIAC MRI: FOLLOW-UP AFTER
AN ALCOHOL SEPTAL ABLATION
Le Franc, Rhythmologist, MD
Godier, Radiologist, MD
Berland, Cardiologist, MD
Clinique Saint-Hilaire, Rouen, France
PATIENT HISTORY
63-year-old male
Indicated for a pacemaker implant because of long
sinus pauses after cardioversion shock, brady-tachy
syndrome and obstructive hypertrophic cardiopathy
at the origins of the alcohol septal ablation indication.
“Images obtained with this system allow a
satisfying analysis of the heart function and
the kinetic is of good quality.”
Dr. Godier, Radiologist
ccent MRI™ DR pacemaker and Tendril MRI™
A
leads implanted.
This system was chosen based on the need of the
patient for a pacemaker and because of the alcohol
septal ablation, which is usually checked through an
MRI examination.
An MRI examination was done before the implant
of the pacing system, and before the alcohol septal
ablation to be used as a reference (Figures 1 and 2).
CARDIAC MRI PROCEDURE
The second MRI exam was indicated to evaluate
the success of the alcohol septal ablation and the
wideness of the infracted area. The MRI mode was
programmed through the Merlin™ programmer
just before the MRI exam (Figure 3). During the
examination, the MRI operator and the radiologist
used ECG to monitor the patient’s cardiac condition
and kept in constant communication with the patient.
“With this type of device, we can now think of
MRI examination, even cardiac MRI scan, for
our pacemaker implanted patients.”
Figure 3. MRI settings enabled pre-MRI scan.
RESULTS
Figures 4 and 5 show the results of the second MRI.
Figure 4 shows that the lead is visible, but it does not
impact the image quality. In Figure 5, the pacemaker
has generated artifacts, but they were avoided when
the radiologist changed the axis to get the picture.
Just after the exam, the pacemaker follow-up checked
the normal functioning of the device (Figure 6).
Dr. Le Franc, Rhythmologist
Tendril MRI™ lead
Septal hypokinesis
Figure 4
Figure 1
2 | Cardiac MRI: Follow-up After an Alcohol Septal Ablation | Case Study No. 4
Accent MRI™ lead
Septal perfusion reduction
Tendril MRI™ lead
Figure 2. Cardiac MRI scan pre-implant.
Figure 5. Cardiac MRI scan post-implant.
CONCLUSION
The Accent MRI™ pacing system allowed the physician
to obtain high-quality MRI images that led to an
accurate diagnosis. The diagnosis would not have been
obtained with a non-MRI compatible pacing system.
The MRI exam evaluated the septal hypokinesis
and provided good visibility of the septal perfusion
reduction. Comments and recommendations included
the following:
Figure 6. Permanent pacing restored post-MRI scan.
“Images are of good quality and give a nice
picture of the alcohol ablation result. This is a
nice cardiac imaging case.”
Dr. Berland, cardiologist who performed the
alcohol ablation
hoice in the imaging axis to get rid of the
C
pacemaker artifacts
s much as possible, implantation of the pacemaker
A
farther from the area to be scanned, as long as this
area is previously known
acing the patient gives the heart a regular rate and
P
helps in getting images
After the examination, permanent settings were
restored in the pacemaker and parameters were
checked. No modifications of the pacing parameters
(pacing and sensing thresholds, lead impedances)
were observed.
Programmed following instructions, the system
presented normal parameters and behavior.
Cardiac MRI: Follow-up After an Alcohol Septal Ablation | Case Study No. 4 | 3
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