Cardiac Implantable Electronic Devices and Magnetic Resonance Imaging

Abstract

Magnetic resonance imaging (MRI) is an excellent body imaging modality. One limitation of MRI is that the physical environment may be a risk for patients with implantable metallic devices. In the past, a cardiac implantable electronic device (CIED) was an absolute MRI contraindication. However, since the introduction of MRI-conditional CIED, the indication for MRI examination has progressed significantly. Cardiac magnetic resonance (CMR) examination can also be performed restrictively in patients with MRI-conditional CIED. With the physical MRI environment, the CIED located near the heart can impact especially a CMR examination focused on the heart. Furthermore, in basis of the physical MRI environment, CMR techniques have been designed for the visualization of a continuously beating heart with minimal image artifact. Therefore, physicians should be familiar with prerequisite conditions for a safe CMR, and prepare the CMR protocol to minimize CIED-related artifacts on CMR images.

MRI in patients with cardiac implantable electronic devices: A comprehensive review

“…This challenge is mainly seen during imaging of the thorax and the heart when a CIED is in situ. The ferromagnetic components in CIED's may produce susceptibility artifacts and signal void during MRI 68,69 potentially causing a poor‐quality image 30,70 …”

“…Susceptibility artifacts are the distortion of the images in gradient sequences owing to the high magnetic susceptibility of the ferromagnetic substances in the CIED leads causing signal loss and dephasing at the tissue lead interphase. Magnetization causes inhomogeneities leading to the dephasing artifact 68,71–73 …”

“…T2‐weighted image artifacts can be reduced by the use of spin‐turbo sequences 68 . The common views used are the two‐chamber view (2CV), four‐chamber view (4CV), and SAV 74,76 .…”

“…The radiologist should be well‐versed with MRI physics and its relation to CIED. The MRI settings should be kept as per the manufacturer's recommendations (in case of MRI‐conditional CIED) or as per other established protocols 133 . These are a few recommended settings in patients with non‐conditional CIEDs…”

Hypersensitivity Reactions to Components of Cardiac Implantable Electronic Devices and Their Treatment: A Systematic Review

“…2 The main components of a CIED in contact with the patients tissues are the pulse generator encasing (made from titanium), the connector head (made from a polymer) and the leads. 3 The materials used to make each of these components varies slightly depending on the manufacturer and type of device.Hypersensitivity reactions (HSR) to metals and epoxies have been reported in orthopaedic, vascular neurosurgical and interventional cardiology in the form of coronary and vascular stents and endovascular occluder devices. [4][5][6][7] HSRs to components of CIEDs are thought to be a rare complication.…”