Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices

Abstract

Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.

Tricuspid valve disease and cardiac implantable electronic devices

“…Artefacts are related to CIED type and size and are worst in CRT-D and subcutaneous ICD. 66 End-inspiration imaging, left arm raise, and fast gradient recall echo with short echo time for cine and wideband late gadolinium enhancement for assessment of myocardial fibrosis are techniques used to minimize artefacts. While visualization of the tricuspid leaflets is often difficult, quantification of baseline and post-intervention RV size, function, reverse remodelling, fibrosis, and eventually TR remain possible and are indicated in case of inconclusive assessment of TR severity or RV volumes and function by echocardiography.…”

Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still “Enemies”?

“…The protocol should include at least three steps to conduct a safe examination in patients with CIEDs [60][61][62].…”

“…Moreover, this protocol could also be applied in other cases where there may be safety concerns for patients with CIEDs, such as those undergoing radiotherapy (RT) for malignancies. In these cases, it is advisable to perform a complete evaluation of the CIED before the RT, minimize any direct exposure of the CIED to radiation, monitor the patient during RT, check the CIED at the conclusion of treatment, and schedule follow-up appointments 1 and 6 months after the treatment [31,[60][61][62]. Figure 10 summarizes the proposed protocol for MRI examinations in patients with CIED.…”

Cardiac magnetic resonance in advanced heart failure

“…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.…”

“…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 …”