Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ
© Quarta et al; licensee BioMed Central Ltd. 2011
Received: 14 February 2011
Accepted: 3 May 2011
Published: 3 May 2011
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.
In the last decade, magnetic resonance imaging (MRI) has grown dramatically. At the same time, a growing number of patients receive cardiovascular implantable electronic devices (pacemaker, implantable-cardioverter defibrillators, bi-ventricular devices), a known contra-indication to MRI. It has been estimated that a patient with a cardiovascular electronic device has a 50-75% lifetime requirement for MRI, which would usually be denied . A position paper from the European Heart Rhythm Association and the Working Group on Cardiovascular Magnetic Resonance of the European Society of Cardiology  and a scientific statement from the American Heart Association  on MRI in individuals with cardiovascular implantable electronic devices have been published. Recently, an MRI-conditional dual chamber pacemaker has become available and represents an important step forward to overcome one of the major limitations of MRI.
Additional file 1: Top: SSFP gradient echo cine (left) and spoiled gradient echo (right) cine four chamber views. SSFP images are more susceptible to artefacts from pacemaker leads, but image quality is good. Bottom: SSFP-GRE short axis views, showing no regional wall motion abnormalities. (AVI 17 MB)
The advent of MRI-conditional devices overcomes an important limitation in disease management. Here, a multidisciplinary team approach and the use and management of two concurrent MR conditional devices  permitted ongoing, comprehensive assessment of multisystem sarcoidosis [4, 5]. Ironically, cardiovascular MRI detected occult cardiac disease that suggests the possible future requirement for an implantable-cardioverter defibrillator. As yet, such devices are not MRI conditional. Fortunately, she has no other high risk features  and her device has not detected any ventricular arrhythmia. Our case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Conflict of interests
The authors declare that they have no competing interests.
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