EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices

Stühlinger, Markus; Burri, Haran; Vernooy, Kevin; Garcia, Rodrigue; Lenarczyk, Radosław; Sultan, Arian; Brunner, Michael; Sabbag, Avi; Özcan, Emin Evren; Ramos, Jorge Toquero; Stolfo, Giuseppe Di; Suleiman, Mahmoud; Tinhofer, Florian; Aristizábal, Julián M.; Cakulev, Ivan; Eidelman, Gabriel; Yeo, Wee‐Song; Lau, Dennis H.; Mulpuru, Silva K; Nielsen, Jens Cosedis; Heinzel, Frank; Prabhu, Mukundaprabhu; Rinaldi, Christopher A.; Sacher, Frédéric; Guillen, R.; Pooter, Jan De; Gandjbakhch, Estelle; Sheldon, Seth H.; Prenner, G.; Mason, Pamela; Fichtner, Stephanie; Nitta, Takashi

doi:10.1093/europace/euac040

Cited by 24 publications

(57 citation statements)

References 121 publications

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“…The management of patients with a CIED (pacemakers and implantable cardioverter defibrillators) receiving RT is challenging and requires a multidisciplinary approach. 64 In the presence of high radiation doses, both software and hardware errors may occur. Direct CIED radiation should be avoided, as this can increase the probability of fatal errors.…”

Section: Radiotherapymentioning

confidence: 99%

“…63 However, there is sufficient evidence that, if necessary, MRI may be performed safely also in non-conditional CIEDs, if specific precautions are taken and a multidisciplinary approach is applied. 63,64 Conclusions and future perspective Cancer patients are at increased risk for acute CV disease. Health care professionals treating these patients and acute cardiac care specialists need to be aware of the potential acute complications of traditional and novel targeted and immune based cancer therapies and should manage these patients in a collaborative multidisciplinary manner.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology—part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias

Gevaert

Halvorsen

Sinnaeve

et al. 2022

European Heart Journal. Acute Cardiovascular Care

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Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to cancer itself or cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. The management of acute coronary syndromes and acute pericardial diseases in cancer patients was covered in part 1 of a clinical consensus document. This second part focusses on acute heart failure, acute myocardial diseases, venous thromboembolic diseases and acute arrhythmias.

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Section: Radiotherapymentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology—part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias

Gevaert

Halvorsen

Sinnaeve

et al. 2022

European Heart Journal. Acute Cardiovascular Care

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“…This guidance aims to support the development of new providers of MRI services to patients with CIED (adults and children) and help the growth of existing services, in order to facilitate equitable provision for those patients in need wherever they may be in the UK. Guidance on MRI scanning of patients with CIEDs from other professional bodies have been considered in the production of these UK recommendations 1–8. This guidance is not intended to provide a comprehensive literature review, which can be found elsewhere 1 9…”

Section: Scopementioning

confidence: 99%

Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices

Bhuva

Ashmore

Lipton³

et al. 2022

Heart

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Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.

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“…These reports, dating back to the late 1980s and early 2000s, contributed to the theory that CIEDs and the MRI environment were not compatible, and, therefore, were contraindicated. Other signifi cant adverse events commemorated in early experience reports are dislodgements or movement of the device, radiofrequency heating of the hardware and surrounding tissue, activation of tachycardia therapies and increased pacing thresholds (14,15,16). Over the past two decades, CIEDs have been designed to reduce the potential risks associated with MRI.…”

Section: Potential Hazards To the Patient With Ciedmentioning

confidence: 99%

“…The European Heart Rhythm Association consensus on the prevention and management of interference due to medical procedures in patients with CIEDs has listed the possible eff ects of electromagnetic interference on these devices. Possible eff ects include inappropriate automatic mode switching, modifi cation of measured pacing/sensing thresholds, over-sensing related adverse events, sudden battery depletion and power-on reset (16). Power-on reset is a specifi c type of reprogramming that reverts the device to the factory default settings when the battery voltage falls below a critical level (15).…”

Section: Potential Hazards To the Patient With Ciedmentioning

confidence: 99%

Mri Safety and Management of Patients With Cardiovascular Implantable Electronic Devices: Literature Review and Case Presentation

GODEC

Izlakar

Podobnik

2022

MIRTJ

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Introduction: MRI has long been contraindicated in patients with CIED devices due to the risk of adverse eff ects through electromagnetic interference. Recent developments in engineering have led to the introduction of MRI conditional CIED devices that do not cause signifi cant clinical harm to patients undergoing MRI, when specifi c imaging conditions are met. Safe access to MRI has become a crucial need for patients with CIED devices. Aim: The purpose of this paper is to present an overview of how to manage patients with implanted CIED devices and to present a case report of a patient with CIED undergoing prostate MRI examination. Methods: This paper explores MRI Safety and the management of patients with implanted CIED devices through an extensive literature review and case presentation. The literature search was conducted using medical scientifi c electronic databases such as PubMed, Cinahl, Wiley Online Library and ScienceDirect. We examined a patient with a CIED device undergoing a prostate MRI examination. Results and discussion: We performed an examination of the described patient in accordance to the guidelines presented in this paper. The MR conditionality status was determined using the device identifi cation card and the manufacturer’s technical manual. The MRI examination of the patient was completed without complications; therefore, no adverse eff ects were reported. The MRI images were without artefacts. Conclusion: Recent clinical studies and published guidelines suggest that MRI of the patients with either an MRI conditional or MRI non-conditional CIED device is relatively safe under specifi c conditions. Multidisciplinary pre-procedure planning, a strict screening process, monitoring and device evaluation protocols are of key importance for ensuring safe MRI imaging in patients with CIED.

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EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices

Cited by 24 publications

References 121 publications

Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices

Mri Safety and Management of Patients With Cardiovascular Implantable Electronic Devices: Literature Review and Case Presentation

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