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

Nyotowidjojo, Iwan; Skinner, Kristina; Shah, Aakash S.; Bisla, Jaskinwal; Singh, Satinder P.; Khoubyari, Rostam; Ott, Peter; Kalb, Bobby; Indik, Julia H.

doi:10.1111/pace.13340

Cited by 14 publications

(11 citation statements)

References 44 publications

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“…According to our large patient dataset and clinical experience, the MRI examinations can be performed safely on patients with CIED without limitations on pacing device type (PM/ICD/CRT-D/CRT-P), pacing device MRI compatibility (MR-conditional/MR-unsafe), patients’ pacing device dependency, or the body region scanned if the dedicated safety protocol is followed. Our finding is supported by previous studies (14,15,19,23,25–27). The Heart Rhythm Society (HRS) published an expert consensus statement on MRI in patients with CIED in 2017 (28).…”

Section: Discussionsupporting

confidence: 93%

“…Recent studies have demonstrated that MRI can be performed safely on patients with CIED, although some changes in device parameters have been noted (14)(15)(16)(17)(18). However, most previous studies have included limitations on patients' pacing device dependency, age of the pacing device, or body region scanned, and patients with abandoned or epicardial pacing leads have been excluded (14,15,19).…”

Section: Introductionmentioning

confidence: 99%

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Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population

et al. 2019

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population

et al. 2019

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“…Long term effects in the form of lead dislodgement or migration of the device within the subcutaneous pocket were not noted. The safety of MRI in the recently implanted devices has been shown to be without any translational effects 90,95 and was confirmed in a retrospective evaluation of recent implants by Friedman et al 100 …”

Section: Clinical Studiesmentioning

confidence: 85%

“…Once safety was reasonably well established at the lowest strength, higher magnetic strengths were tried and were found to be well tolerated 8,67,84–93 . To keep the adverse effect of RF and gradient magnetic field at minimum most of the studies had maximum SAR of 2 W/kg (3.2 W/kg for head MRI) and slew rate of 200 T/m/s 85,92,94–96 . A few newer parameters like patient‐specific energy dose (SED) 67 (≤0.2 kJ/kg) and root mean square (RMS) of the flip angle (B1+) (B 1+RMS ) (≤2.8μT) 38 have been proposed recently but remain unvalidated for clinical use and safety.…”

Section: Clinical Studiesmentioning

confidence: 99%

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

Deshpande

Kella

Padmanabhan

2021

Pacing Clinical Electrophis

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Magnetic resonance imaging (MRI) has become a commonly used non‐ionizing radiation dependent imaging modality which has an excellent spatial resolution with the capability to provide physiological information. Cardiac implantable electronic devices (CIEDs) are used in modern cardiology with a frequency of 1:50 over 75 years of age and nearly one in three people in this population required MRI during their lifetime. Changes in the CIED structure, electronics, and algorithms paired with changes in the protocol design of MRI have created a relatively safe environment for performing MRI in patients with CIED. Despite their documentation in literature and a guideline document from a professional society, significant skepticism exists in doing MRI in patients with CIEDs. We intend to give an overview of interactions between MRI and CIEDs, including the evidence available in this regard and conclude with the suggestion of a protocol for safely carrying out an MRI in patients with CIEDs.

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Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

et al. 2021

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IMPORTANCE Magnetic resonance imaging (MRI) is the modality of choice for many conditions. Conditional devices and novel protocols for imaging patients with legacy cardiac implantable electronic devices (CIEDs) have increased access to MRI in patients with devices. However, the presence of abandoned leads remains an absolute contraindication.OBJECTIVE To assess if the performance of an MRI in the presence of an abandoned CIED lead is safe and whether there are deleterious effects on concomitant active CIED leads. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included consecutive CIED recipients undergoing 1.5-T MRI with at least 1 abandoned lead between January 2013 and June 2020. MRI scans were performed at the Hospital of the University of Pennsylvania. No patients were excluded.EXPOSURES CIEDs were reprogrammed based on patient-specific pacing needs. Electrocardiography telemetry and pulse oximetry were monitored continuously, and live contact with the patient throughout the scan via visual and voice contact was performed if possible. After completion of the MRI, CIED evaluation was repeated and programming returned to baseline or to a clinically appropriate setting.MAIN OUTCOMES AND MEASURES Variation in pre-and post-MRI capture threshold of 50% or more, ventricular sensing 40% or more, and lead impedance 30% or more, as well as clinical sequelae such as pain and sustained tachyarrhythmia were considered significant. Long-term follow-up lead-related data were analyzed if available.RESULTS A total of 139 consecutive patients (110 men [79%]) with a mean (SD) age of 65.6 (13.4) years underwent 200 MRIs of various anatomic regions including the thorax. Repeat examinations were common with a maximum of 16 examinations for 1 patient. There was a total of 243 abandoned leads with a mean (SD) of 1.22 (0.45) per patient. The mean (SD) number of active leads was 2.04 (0.78) and 64 patients (46%) were pacemaker dependent. A transmit-receive radiofrequency coil was used in 41 patients (20.5%), all undergoing MRI of the brain. There were no abnormal vital signs or sustained tachyarrhythmias. No changes in battery voltage, power-on reset events, or changes of pacing rate were noted. CIED parameter changes including decreased right atrial sensing in 4 patients and decreased left ventricular R-wave amplitude in 1 patient were transiently noted. One patient with an abandoned subcutaneous array experienced sternal heating that subsided on premature cessation of the study. CONCLUSIONS AND RELEVANCEThe risk of MRI in patients with abandoned CIED leads was low in this large observational study, including patients who underwent examination of the thorax. The growing aggregate of data questions the absolute contraindication for MRI in patients with abandoned CIED leads.

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

Abstract: CIED variable differences following MR scan were not dependent on the region scanned (thoracic vs nonthoracic) and there were no clinical adverse effects in this prospective cohort.

Cited by 14 publications

References 44 publications

Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population

Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population

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

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

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