Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: best practice and real-world experience

Abstract

Aims Cardiovascular magnetic resonance (CMR) imaging has long been a contraindication for patients with a cardiac implantable electronic device (CIED). Recent studies support the feasibility and safety for non-thoracic magnetic resonance imaging, but data for CMR are sparse. The aim of the current study was to determine the safety in patients with magnetic resonance (MR)-conditional or non-MR-conditional CIED and to develop a best practice approach. Methods and results All patients with a CIED undergoing CMR imaging (1.5 T) between April 2014 and April 2017 were included in the study. Devices were programmed according to the standardized protocol directly before and after the CMR examination. Follow-up interrogation was performed 6 months after CMR examination. Results were compared with a large, reference cohort of CIED patients not undergoing any MR examination. A total of 200 consecutive patients with a CIED (non-MR-conditional, n = 103) were included in the study. Directly after CMR imaging, one device failure (0.5%, battery status = end of service) was noted necessitating premature generator replacement. In three patients (2%) of pacemaker/implantable cardioverter-defibrillator (ICD) carriers a sustained ventricular tachycardia (VT) occurred during CMR imaging. Ten ICD showed a decrease in battery capacity immediately after CMR. Overall, the reference cohort showed comparable changes of CIED function during follow-up. Conclusion With adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory.

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

“…The cause of battery depletion may be multifold—transient increase in lead impedance and threshold, 62 transient power interruption, 17 or overuse due to inappropriate sensing 64–66 . Similar findings were seen in ICDs also 67 . This has the potential to be alarming in the patients who are in ERI at the time of MRI.…”

“…Most of the studies have shown that battery voltage remained stable after MRI 107 . But in the some of the recent studies, there was a mild decrease in battery voltage after MRI in ICDs, 67 which was also confirmed on the recent meta‐analysis (2.2% cases had battery depletion of >0.04 V) 99 . A small study focused on this issue done in MRI non‐conditional devices at elective replacement indicator (ERI) in non‐pacing dependent patients, showed safety in ICDs, but two POR events in PPM (2/13, i.e., 15.4%) 106 .…”

“…The earliest studies in patients were done with the lowest strength of static magnetic field, that is, 0.5 T 34,62,82,83 . 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 .…”

“…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.…”

Need for MRI scans in a real–world CIED population over long-term follow-up: Data from a large single-centre experience

“…In fact, the HRS recommendations on MRI in CIED patients (class IIa, level of evidence B) [11] state an MRI scan can be performed in patients without an MRI conditional device, provided that there are no fractured, epicardial or abandoned leads. Many studies have already demonstrated that MRI scans, even in patients without MRI conditional devices, are not linked to any particular harmful events [12][13][14], especially if a specific protocol has been designed by the centre conducting the MRI examinations [15,16]. If there were no difference in cost between MRI conditional and non-MRI conditional devices, there would be no reason to use non-MRI conditional devices.…”