Since 1958, when the world’s first fully embedded pacemaker implantation was successfully completed, and after more than half a century of continuous innovation, development and improvement, the functions of pacemakers have tended to diversify to meet the diverse needs of clinical patients. Pacemaker implantation has become one of the main treatments for cardiac arrhythmias and cardiac insufficiency. However, permanent pacemaker implantation, while providing patients with improved quality of life and life extension, inevitably brings another kink-the prohibition of MRI examinations. Epidemiological studies have shown that patients over the age of 65 are twice as likely to require an MRI than younger patients, but almost all implantable pacemaker manufacturers’ websites clearly state that MRI exams are contraindicated and recommend avoiding them. The American College of Radiology (ACR) and the Radiological Society of North America (RSNA) warn that the magnetic fields generated by MR systems can cause pacemakers to malfunction and pose a direct risk to patients. Care Min, Department of Cardiology, The First Affiliated Hospital of Henan Medical College of Traditional Chinese Medicine Magnetic resonance imaging (MRI) is the next major advancement after CT imaging. After 40 years of clinical application, MRI has developed into a widely used diagnostic imaging tool that cannot be replaced by multi-row CT because of its advantages of non-invasive, non-radiographic and high resolution. According to data, the average age of patients treated with pacemaker implants in China is around 70 years old, which is a high incidence age for cardiovascular and cerebrovascular diseases, tumors, and bone and joint diseases, and MRI examination is uniquely advantageous for the diagnosis of these diseases. Foreign studies show that about 75% of pacemaker implant patients may require magnetic resonance imaging (MRI) examination later. The US FDA safety guidelines also specify that “patients with pacemakers and other internal electronic implants should not receive MRI within 5 gauss lines (0.5 mT). However, recent clinical studies have shown that it is safe for pacemaker patients to undergo MRI examinations. The AHA issued a statement in 2007 that for most devices, the benefits may outweigh the risks if there are no clear contraindications to MRI examinations.Sources of danger in MRI Magnetic resonance imaging techniques involve placing the body in a special magnetic field and using radiofrequency pulses to excite the nuclei of hydrogen atoms in the body, causing them to resonate and absorb energy. After stopping the radio frequency pulse, the hydrogen nucleus emits radio signals at a specific frequency and releases the absorbed energy, which is passed through an external receiver and processed by an electronic computer to obtain images. The pacemakers currently used in clinical practice contain many metal components. When a patient with a pacemaker implanted in the body undergoes MRI examination, the human body is placed in a strong applied static magnetic field and a changing spatial gradient magnetic field, and the interaction between the magnetic field and the ferromagnetic components of the pacemaker under the action of the strong magnetic field and magnetic torque of MRI can cause displacement, functional disorders and strong local currents of the implanted device in the body. In some cases, the implantation device may malfunction, and in others, local burns, cardiac arrhythmias or even cardiac arrest may occur. The risks of MRI are mainly due to the field strength of the static magnetic field, the field strength of the spatial gradient magnetic field and the radio frequency strength of the magnetic field. The FDA uses the terms “MR safe”, “MR conditionally safe”, and “MR unsafe” to indicate the safety of implanted devices when undergoing MRI examinations. Safety ratings. Permanent pacemakers contain magnetic components and are sophisticated electronic devices that may be subject to risks such as displacement, alteration of program data, abnormal operation or non-operation under MRI. MRI is still very controversial, and pacemakers and ICDs are still contraindications to MRI. For this reason, the FDA has labeled pacemakers as “MR unsafe”. A study of the safety of patients with pacemakers Sutton et al reported on 928 non-cardiac MRI examinations in 464 patients with Medtronic pacemakers. The results did not reveal any complications of MRI examinations. Martin et al studied 54 non-pacing dependent patients before and after 64 MRI examinations and found no changes in electrode impedance or battery voltage and no loss of seizure, although electrode thresholds changed in about 1/3 of patients, only about 10%, without clinical significance. . Nazarian et al evaluated the before and after changes in pacemakers in a group of patients undergoing chest and cardiac MRI. 12 of 55 patients were pacemaker-dependent and underwent a total of 31 MRI examinations, including 2 in the chest and 29 in the heart. The preoperative program control was fixed mode, and the radiofrequency energy absorption rate (SAR) was limited to less than 2.0 W/Kg. All patients eventually completed the MRI examinations safely without pacemaker failure. Gimbel et al reported no significant changes in electrode pacing, perception, impedance, charging time, or battery status before and after MRI in seven patients with ICDs. Nazarian et al. also looked at MRI in patients with ICD implants. All patients had a closed ICD prior to MRI and the ICD functioned normally after MRI with no impairment. So far, no serious adverse events have been reported in all studies of MRI in patients with pacemakers, although no consistent conclusions have been drawn due to different sample sizes, different pacemaker models and manufacturers, different MRI device models and manufacturers, and different scanning sites. However, we still see hope. With the increasing clinical and patient demand for MRI, it is especially important to find a solution that allows pacemaker implanted patients to safely undergo MRI scans. The SureScan pacing system consists of the EnRhythm MRI SureScan pacemaker and the 5086 CapSureFix MRI electrode. The pacemaker effectively controls the reed switch to prevent electrical resetting due to electromagnetic interference and to reduce heating of the electrode leads due to RF fields (cross-conversion fields). The electrodes are redesigned to reduce the interaction of the electrodes with the gradient magnetic field of MRI and the RF field, and to reduce the heating of the leads. Therefore, the entire pacing system is able to work properly in the MRI magnetic field environment. In a multicenter, randomized clinical study, 464 patients were implanted with the SureScan pacing system and randomized to either MRI scans (MRI group) or no MRI scans (control group) with MRI at the commonly used, clinically indicated scan intensity of 1.5 T. Follow-up was 11.2 ± 5.2 months. The results of the study showed that the SureScan™pacing system proved to be safe for MRI examinations in patients, with a complete absence of MRI-related complications (n = 211, p < 0.001). In contrast, Sommer et al7 reported no significant difference in lead pacing thresholds between the MRI-scanned and non-MRI-scanned groups at 4-month follow-up after patients underwent MRI. The SureScan pacing system is the first safe pacing system under MRI to receive CE approval and FDA clearance for pacemaker implantation in patients over 65 years of age with risk factors for stroke For patients over 65 years of age with a history of hypertension, diabetes, osteoarthritis, spine related diseases and associated tumor risk factors, the implantation of an MRI resistant pacing system is recommended in consideration of the possibility of MRI scans after pacemaker implantation. In addition, preimplantation of MRI-resistant pacing systems may be considered in patients with a history of MRI prior to pacemaker implantation or in younger patients in good general condition who require pacemaker support for the rest of their lives. To date, cardiac pacing technology is still evolving rapidly, with many new features and technologies being introduced every year, which will certainly improve pacemaker technology and bring greater benefits to pacemaker wearers.