2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices

Indik, Julia H.; Gimbel, John; Abe, Haruhiko; Teixeira, Ricardo Alkmim; Birgersdotter‐Green, Ulrika; Clarke, Geoffrey D.; Dickfeld, Timm; Froelich, Jerry W.; Grant, Jonathan D.; Hayes, David L.; Heidbüchel, Hein; Idriss, Salim F.; Kanal, Emanuel; Lampert, Rachel; Machado, Christian; Mandrola, John; Nazarian, Saman; Patton, Kristen K.; Rozner, Marc A.; Russo, Robert J.; Shen, Win Kuang; Shinbane, Jerold S.; Teo, Wee Siong; Uribe, William; Verma, Atul; Wilkoff, Bruce L.; Woodard, Pamela K.

doi:10.1016/j.hrthm.2017.04.025

Cited by 344 publications

(396 citation statements)

References 132 publications

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“…While there is some neutron production from 10‐MV beams (and even at lower energies), the neutron flux increases dramatically above 10 MV. Therefore, in this report, and consistent with the recommendations from other reports, 10‐MV photon beams are considered to be not neutron producing in the context of risk management for patients with CIEDs.…”

Section: Conditions In Clinical Use That Can Induce Malfunctionssupporting

confidence: 74%

“…In clinical practice, it is difficult to distinguish between the three classes . In RT practice, it is the cardiologist’s realm to state the patient’s device dependence for the appropriate management during RT …”

Section: Icp and Icd Devicesmentioning

confidence: 99%

“…The most common effect observed was oversensing . Over‐sensing in ICPs may result in an inappropriate inhibition of pacing output, with the additional complication of possibly triggering unnecessary tachyarrhythmia therapy in ICDs . Based on these studies, the effects were transient and were only observed during direct irradiation of the CIED generator.…”

Section: Malfunction Risk Associated With Clinical Proceduresmentioning

confidence: 99%

“…In 2017, the Heart Rhythm Society (HRS) published their expert consensus statement on cardiac devices. While the focus of this report was on MRI interactions with CIEDs, this report also discussed management of RT patients (Section 7 in that report) . In their report, HRS focused on avoiding the use of neutron‐producing beams (e.g., photons of E >10 MV or protons), and considered a 5 Gy dose threshold, but were ultimately unable to make a recommendation concerning cumulative dose risks.…”

Section: Introductionmentioning

confidence: 99%

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

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Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter‐defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG‐34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

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Section: Conditions In Clinical Use That Can Induce Malfunctionssupporting

confidence: 74%

Section: Icp and Icd Devicesmentioning

confidence: 99%

Section: Malfunction Risk Associated With Clinical Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

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“…Guidance regarding performing MRI examinations in patients with non‐MR Conditional cardiac devices including implanted pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy pacemakers, and cardiac resynchronization therapy defibrillators is deferred to current recommendations from the Heart Rhythm Society recommendations …”

Section: Refinements To Previously Published Acr Guidance On Mr Safe mentioning

confidence: 99%

ACR guidance document on MR safe practices: Updates and critical information 2019

Greenberg¹,

Hoff

Gilk³

et al. 2019

Magnetic Resonance Imaging

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The need for a guidance document on MR safe practices arose from a growing awareness of the MR environment's potential risks and adverse event reports involving patients, equipment, and personnel. Initially published in 2002, the American College of Radiology White Paper on MR Safety established de facto industry standards for safe and responsible practices in clinical and research MR environments. The most recent version addresses new sources of risk of adverse events, increases awareness of dynamic MR environments, and recommends that those responsible for MR medical director safety undergo annual MR safety training. With regular updates to these guidelines, the latest MR safety concerns can be accounted for to ensure a safer MR environment where dangers are minimized. Level of Evidence: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:331–338.

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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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2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices

Cited by 344 publications

References 132 publications

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

ACR guidance document on MR safe practices: Updates and critical information 2019

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

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2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices

Cited by 344 publications

References 132 publications

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

ACR guidance document on MR safe practices: Updates and critical information 2019

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

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Product

Resources

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†