Impact of magnetic resonance imaging on functional integrity of non‐conditional cardiovascular implantable electronic devices

Abstract

Background Cardiovascular implantable electronic devices (CIEDs) have historically restricted the use of magnetic resonance imaging (MRI) due to the potential clinical and configurational risks associated with electromagnetic interference. In this study, the authors investigated the impact of MRI on the functional integrity of non‐conditional CIEDs and their clinical correlates. Methods In this prospective, observational single‐center study, we enrolled patients undergoing MRI over a 5‐year period. Prior to assessing the impact of MRI on CIEDs, we performed interrogations in sequential duplication to assess the intrinsic variability of devices. Subsequently, we performed interrogations immediately after MRI, and monitored changes in device parameters and clinical events. Results We completed 492 MRI studies, 58% in patients with permanent pacemakers (PPMs) and 42% with implantable cardioverter defibrillators (ICDs). Subsequent MRI exposures occurred in 15% encounters. Accounting for intrinsic variability in CIED leads, there were no significant changes in RA, RV, or LV parameters after MRI, regardless of the region imaged (thoracic vs. non‐thoracic), type of CIED (PPMs vs. ICDs) and among those with serial MRIs. When ranked for % change pre‐ to post‐MRI, the majority of RA, RV, and LV metrics for thresholds, sensing, and impedance conformed to ≤20% change from baseline. No significant clinical adverse cardiac events or effect on device microcircuitry occurred during the study. Conclusion Incorporating a novel reproducibility tactic, there were neither clinically meaningful device parameter changes nor adverse clinical events during or following MRIs, suggesting the effects of MRI on non‐conditional CIED integrity are far less than previously perceived.

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

“…Findings of this meta-analysis are in accordance with the growing number of studies (1,11,15,(18)(19)(20)(21)(22)(23)(24)(25) demonstrating that comparatively minor device alterations such as a slightly depleted battery or altered pacing thresholds do not result in signifi cant adverse outcomes. While there is a growing body of evidence supporting the safety of MRI in patients with conditional and non-MRIconditional devices, the evidence base supporting the safety of thoracic MRI examinations in such patients is limited to few single-centre studies (26)(27)(28).…”

Cardiac Magnetic Resonance Imaging for the Diagnosis of Infective Endocarditis in the COVID-19 Era

“…26 , 27 , 28 For limitations related to CIEDs, recent studies demonstrate that CMR in non-MRI-conditional systems, including those with hybrid configurations, is feasible and safe without clinically meaningful device parameter changes or adverse events. 29 , 30 Though, abandoned leads remain a challenge. 31 , 32 , 33 , 34 Recent advances in wideband LGE protocols, for both segmented and single-shot sequences, have demonstrated efficacy in accurately reducing device-related artifact, particularly with transvenous ICDs and cardiac resynchronization therapy devices.…”