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We thank our correspondents for their valuable suggestions and additional points. They underline again the intention of our review article, which was to make it clear that MRI scans are no longer absolutely contraindicated in patients with pacemakers, but that for every individual case, a decision will have to be made about whether the potentially serious risks are balanced out by a corresponding benefit for the patient. The complexity of such a risk assessment arises materially from the multitude of available pacemaker systems and probes and their possible combinations. Dr Hansky rightly reminds us that when using technically possible combinations of MRI-compatible aggregates with non-MRI-compatible probes or MRI-compatible probes from another manufacturer, the licensing approval for the complete system for conducting MRI scans is void. This also underlines the need for specialist cardiological consultations and monitoring even of patients with presumably MRI-compatible systems before they undergo an MRI scan.

We thank Dr Nähle and Dr Lüchinger For their helpful addendum relating to the use of 3 tesla in combination with restricted RF fields to the head when investigating the cerebrum, as well as their detailed explanation of the relevant terminology used in the context of CE certification of pacemakers.

The contributions from Dr Hansky as well as from Dr Nähle and Dr Lüchinger also underline the position we took in our article, that MRI scans in patients with pacemakers should be conducted only at experienced centers and under stringent safety precautions. This also applies for the new MRI-conditional pacemaker systems.

DOI: 10.3238/arztebl.2012.0644

Priv.-Doz. Dr. med. Carsten Zobel

Abteilung für Kardiologie, Marienhospital Euskirchen

carsten.zobel@marien-hospital.com

Dr. med. Henning Bovenschulte

Institut und Poliklinik für Radiologische Diagnostik, Uniklinik Köln

Conflict of interest statement
Dr Zobel has received conference delegate fees and travel expenses from Medtronic, Pfizer, and Lilly. Furthermore he has received honoraria for preparing medical educational events from St Jude Medical, Medtronic, Bayer, and Boehringer Ingelheim.
Dr Bovenschulte declares that no conflict of interest exists.

1.
Bovenschulte H, Schlüter-Brust K, Liebig T, Erdmann E, Eysel P, Zobel C: MRI in patients with pacemakers—overview and procedural management. Dtsch Arztebl Int 2012: 109(15): 270–5. VOLLTEXT
1.Bovenschulte H, Schlüter-Brust K, Liebig T, Erdmann E, Eysel P, Zobel C: MRI in patients with pacemakers—overview and procedural management. Dtsch Arztebl Int 2012: 109(15): 270–5. VOLLTEXT