Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads

Padmanabhan, Deepak; Kella, Danesh; Mehta, Ramila A.; Kapa, Suraj; Deshmukh, Abhishek; Mulpuru, Siva K.; Jaffe, Allan S.; Felmlee, Joel P.; Jondal, Mary Lou; Dalzell, Connie; Asirvatham, Samuel J.; Cha, Yong‐Mei; Watson, Robert E.; Friedman, Paul A.

doi:10.1016/j.hrthm.2017.10.022

Cited by 75 publications

(56 citation statements)

References 22 publications

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“…Similarly, no adverse events were seen with MRI in a cohort that included nine patients with epicardial leads, and in nine congenital heart disease patients with epicardial leads . Recently, a larger cohort of 80 patients with abandoned leads was reported with no adverse effects and no significant changes in troponin values . The 2017 HRS consensus statement on MR imaging makes no recommendations for MR scanning for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device

Nyotowidjojo

Skinner

Shah

et al. 2018

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device

Nyotowidjojo

Skinner

Shah

et al. 2018

Pacing Clinical Electrophis

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“…The presence of an epicardial or abandoned lead may be an exclusion at a particular institution, but this type of patient is not addressed by current recommendations. There is a growing understanding of the risks and risk mitigation in these scenarios, so patients are not systematically excluded [31]. Overly rigid selection protocols may therefore cause patients more harm (from not scanning) than good.…”

Section: Protocols For Mri In Patients With Ciedsmentioning

confidence: 99%

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

et al. 2019

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More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this-newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.

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“…Three posters at HRS 2017 addressed the use of MRI in patients with devices and abandoned leads. [13][14][15] Across all three studies, there were 92 patients with 117 MRI scans included, with all showing that there was no clinical or electrical evidence of any CIED dysfunction, and no occurrence of arrhythmia or pain during the scan. These data show significant promise, and we look forward to reading these completed manuscripts to see details on the inclusion and exclusion criteria.…”

Section: Poster Presentationsmentioning

confidence: 99%

Highlights from Heart Rhythm Society 2017: Innovations in Electrophysiology Patient Management, and Beyond

Sugrue¹,

Vaidya²,

Asirvatham³

2017

J Innov Cardiac Rhythm Manage

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On the other hand, it is possible that AF detected by ICM does increase stroke in the long term. The risk might become apparent as the PREDATE AF, ASSERT II, and REVEAL AF cohorts are followed long term. Can anticoagulation for ICM-detected silent AF reduce stroke risk significantly? The ongoing NOAH (https:// clinicaltrials.gov/ct2/show/NCT02618577) and ARTESiA (https://clinicaltrials.gov/ct2/show/NCT01938248) trials are expected to provide much-needed information regarding the modification of stroke risk in patients with incidentally detected AF.

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Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads

Cited by 75 publications

References 22 publications

Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device

Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

Highlights from Heart Rhythm Society 2017: Innovations in Electrophysiology Patient Management, and Beyond

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