A pacemaker is a
device for internal or external battery-operated
cardiac pacing to overcome
cardiac arrhythmias or heart block. All implanted electronic devices are susceptible to the electromagnetic fields used in
magnetic resonance imaging. Therefore, the main
magnetic field, the
gradient field, and the
radio frequency (RF) field are potential hazards for
cardiac pacemaker patients.
The pacemaker's
susceptibility to static field and its critical role in life support have warranted special consideration. The static
magnetic field applies force to magnetic materials. This force and
torque effects rise linearly with the
field strength of the
MRI machines. Both, RF fields and
pulsed gradients can induce voltages in circuits or on the pacing lead, which will heat up the tissue around e.g. the lead tip, with a potential risk of thermal injury.
Regulations for pacemakers provide that they have to switch to the
magnet mode in static magnetic fields above 1.0 mT. In
MR imaging, the
gradient and RF fields may mimic
signals from the heart with inhibition or fast pacing of the heart. In the
magnet mode, most of the current pacemakers will pace with a fix pulse rate because they do not accept the heart
signals. However, the state of an implanted pacemaker will be unpredictable inside a strong
magnetic field. Transcutaneous controller adjustment of pacing rate is a feature of many units. Some achieve this control using switches activated by the external application of a
magnet to open/close the switch. Others use rotation of an external
magnet to turn internal controls. The
fringe field around the
MRI magnet can activate such switches or controls. Such activations are a
safety risk.
Areas with fields higher than 0.5 mT (
5 Gauss Limit) commonly have restricted access and/or are posted as a
safety risk to persons with pacemakers.
A
Cardiac pacemaker is because the
risks, under normal circumstances an absolute
contraindication for
MRI procedures.
Nevertheless, with special precaution the
risks can be lowered. Reprogramming the pacemaker to an asynchronous mode with fix pacing rate or turning off will reduce the risk of fast pacing or inhibition. Reducing the SAR value reduces the potential
MRI risks of heating. For
MRI scans of the
head and the lower
extremities, tissue heating also seems to be a smaller problem. If a
transmit receive coil is used to scan the
head or the feet, the
cardiac pacemaker is outside the sending
coil and possible heating is very limited.