Magnetic resonance imaging in patients with cardiac implantable electronic devices

Abstract

In recent years the prevalence of implantation of a cardiac implantable electronic device (CIED) has increased due to expanding implantation indications and prolonged life expectancy. Diagnostic strategies increasingly employ magnetic resonance imaging (MRI) to aid therapeutic strategies. In earlier guidelines, MRI was contra-indicated in patients with CIEDs, mainly due to previous reports of severe complications. With the development of MRI-conditional CIEDs and recent evidence concerning non-MRI-conditional CIEDs, MRIs in CIED patients can be safely performed in many hospitals.However, there are several questions that need to be addressed. Which patients can we scan? How can the scans be performed safely? And last but not least, can cardiac MRI provide diagnostic yield in patients with CIEDs?Current European guidelines are rather outdated and vague about patient selection and practical issues. There are national guidelines on this topic but several issues need extra attention and those are addressed in this point of view. It is important to create an environment with proper patient selection without unnecessary MRI scans in CIED patients, but also without unnecessary fear of complications, preventing access to MRI in patients who can benefit from this powerful diagnostic tool.

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

“…Previously cardiac MRI was thought to be difficult, if not impossible, in the patients with CIED but recent publications have shown that even in the legacy devices the use of MRI is safe 123 . In many of these patients the newer sequences, such as wideband pulse sequence and inversion recovery sequence, were used to reduce artifacts 124,125 .…”

“…There have been several recent publications suggesting different safety protocols for carrying out an MRI in patients with CIED 11,12,94,123,130,131,134–136 . The overall idea of the protocol is as summarized in Figure 3.…”

Kutanes Plattenepithelkarzinom mit Gesichtslähmung: gutes Ansprechen auf Cemiplimab

“…Da das MRT die empfindlichste bildgebende Methode zur Erkennung perineuraler Tumorausbreitungen (PNTS) ist [2] und da eine Änderung der Empfehlungen für die Bildgebung bei Patienten mit implantierten Herzgeräten eingeführt wurde [3,4], wurde jetzt ein MRT durchgeführt. Es zeigte eine infiltrative Gewebsvermehrung im rechten Jochbein, die in den rechten Ohrmuschelbereich infiltrierte und die Hirnnerven (HN) V und VII in Mitleidenschaft zog (Abbildung 1b, c).…”

Cutaneous squamous cell carcinoma presenting with facial paralysis: good response to Cemiplimab

“…Given that MRI is the most sensitive imaging method for the detection of perineural tumor spread (PNTS) [2], and that a change in recommendations for imaging in patients with cardiac implantable devices has been implemented [3,4], an MRI was performed. It showed an aggressive mass in the right zygomatic bone that infiltrated the right auricular area, affecting both cranial nerves (CN) V and VII (Figure 1b, c).…”