SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

Cardiac magnetic resonance in advanced heart failure

“…97 Furthermore, balanced SSFP sequences are the most dangerous in terms of a lead-tip heating phenomenon because they often use large flip angles that can lead to higher RF energy deposits in the patient. 98 The gradient magnetic fields are magnetic fields that are continuously switched on and off during the scan since they are used for spatial encoding. Similarly to what happens with RF fields, this temporary magnetic field can induce an electrical current that stimulates peripheral nerves (so-called peripheral nerve stimulation phenomenon) or interfere with the pacing and sensing functions.…”

“…99 To perform the scan, following international guidelines on CMR examination on patients with CIED as well as local protocols is advisable. 98,100 In the event of a life-threatening arrhythmia, it is important to remember that ICD shock in the scanner area could fail due to possible interference of the magnetic static field on the ICD capacitor. 101 Although the above-mentioned pitfalls to be aware of, with due precautions scanning patients with CIED is generally safe and it is becoming gradually more common in clinical practice.…”

“…92 There are many strategies to mitigate these effects of CIEDs on CMR, like increasing the distance between the generator and the heart by lifting the left arm, 102 using deep learning techniques to overcome the artifacts, 103 or using smaller voxels, and smaller echo times with shorter RF pulses and larger receiver bandwidth in the frequency encoded direction. 98 A technique that showed the best results in correcting the artifacts is the use of wideband inversion pulses for IR or saturation recovery (SR) sequences. When applying these sequences, the CIEDs cause an off-resonance that undermines the presequence pulse preparation (like IR or SR), making the images very difficult to read.…”

“…When applying these sequences, the CIEDs cause an off-resonance that undermines the presequence pulse preparation (like IR or SR), making the images very difficult to read. 98 Using a wider spectral bandwidth was proposed by Rashid et al 104,105 and has been proven to be effective in clinical practice. 105,106 Other devices can be used as therapy in advanced HF, such as cardiac contractility modulators and interatrial shunt devices.…”

“…108,109 A cardiac contractility modulator is a transvenous device with a catheter to the right interventricular septum (IVS) that delivers high voltage impulses in the RV during the absolute refractory period, improving the calcium handling of the myocytes; this device is MR conditional only at 1,5 T for the head and the extremities. 98,110 In conclusion, the timing of scans poses challenges when managing CMR and advanced HF patients. There are instances where HF patients may find it difficult to tolerate extended periods of supine positioning or prolonged breath-holding requirements during scanning procedures.…”