p.58 抽出テキスト

................... Evaluation must be made on a case by case basis by balancing the advantages of MRI with the potential risks and availability of alternative imaging methods and using shared decision-making.

In general, MRIs should always be performed in the context of a rigorously applied standardized institutional workflow, following the appropriate conditions of use (including programming).744,746,753755 A flowchart summarizing the management of patients with a pacemaker undergoing MRI is shown in Figure 14.

There is evidence indicating that 1.5 T MRIs may be performed in patients with temporary epicardial wires756 as well as with transvenous pacemaker active fixation leads implanted to externalized pacemakers used for temporary pacing.751

Integrated management of patients with pacemaker and CRT

Emphasising patient-centred care and shared decision making

Ensure optimal device selection and implantation Pre-implant assessment and adherence to

low-risk implantation surgery

Provide physiological pacing

and symptom control Structured follow-up with tailored device programming

(remote monitoring and in-office)

Management of underlying

cardiac disease Including stroke prevention in atrial fibrillation and

heart failure optimization

Patient education/ self-management Including personal goals and/or action plan

Healthcare professional

education Including certifications for optimal quality

in relevant specialities

Lifestyle modification Smoking cessation, alcohol, dietary

and exercise interventions

Psychosocial management

and support Psychological assessment and/or treatment

Strategies to promote

medical adherence Educate patients about what to expect from the device and

medical treatment using available technologies

Multidisciplinary team approach Including different disciplines when relevant; electrophysiologists, cardiologists, nurses, allied professionals,

psychologist, dietician and pharmacist

Clear communication between primary and

secondary care Including timely end-of-life discussions

Figure 13 Integrated management of patients with pacemaker and cardiac resynchronization therapy. CRT = cardiac resynchronization therapy. Downloaded from academic.oup.com/eurheartj/article/42/35/3427/6358547 by guest on 07 October 2026