BIOTRONIK ProMRI - Page 9

PAGE 9
The device system consists of a pacemaker, ICD, or CRT-D with the
respective leads that are separately labeled MR conditional and,
when combined, constitutes an MR conditional device system
(See charts on p. 10).
There are no other active or abandoned cardiac implants (e.g., lead
extensions, lead adapters or abandoned leads) in the patient’s body.
Other active or passive implants are permitted if they are identified
as MR conditional by the manufacturer.
Note: An MRI scan is permitted only if the product-specific
conditions are met for all implants and if no metal implantable
device longer than 5 cm is in the vicinity of a BIOTRONIK lead
within a distance of less than 4 cm.
The leads have been implanted for at least 6 weeks.
The device system is implanted pectorally.
The measured pacing threshold is not above 2.0 V at 0.4 ms
pulse width.
The device system should be functioning normally prior to an MRI.
The battery status is neither ERI nor EOS.
Ensure that the device is programmed to an MRI mode before the
MR scan and reprogrammed to the initial settings after the scan.
Post MR scan requirements met (See p. 10).
Date
Name and signature
ProMRI
®
checklist for the cardiology department (continued)
*
Detals on these condtons and requrements can be found n the BIOTRONIK ProMRI
®
System
Techncal Manual (wwwbotronkusacom/manuals) Alternatvely, contact your local BIOTRONIK
representatve or vst wwwbotronkusacom/promr