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Potential harmful effects of magnetic resonance imaging in pacemaker patients should not be underestimated.

We read with great interest the article by Irnich et al .,1 in which the authors address the question whether future pacemakers, improved for magnetic resonance imaging (MRI) resistance, are needed. The authors report, for the first time, a systematic investigation on the causes of fatalities that occurred during MRI investigation and reported by Legal Medicine Departments in Germany. In this respect, the authors discuss several potential interactions between pacemakers and MRI, such as heating effects, reed-switch closure in strong magnetic fields, and stimulation and influence of sensing due to the gradient fields. The authors conclude that a small modification of the MRI unit and programmability of the magnet function of the pacemaker is all that is needed to make pacemakers compatible with MRI examinations.

In our opinion, the authors underestimate three main risks: inadvertent changes in pacing mode, induced voltage due to gradient fields, and the …