Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

Abstract

Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers.

Cardiac Implantable Electronic Devices and Magnetic Resonance Imaging

“…Thus, CMR imaging has become a valuable tool for non-invasive heart disease detection and characterization [2][3][4][5]. Cardiac implantable electronic device (CIED) generally refers to implanted cardiac pacing devices, such as the cardiac pacemaker (PM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) [6][7][8]. The CIED consists of complex electronic and ferromagnetic components that can physically interact with the MRI environment [6,8].…”

“…Cardiac implantable electronic device (CIED) generally refers to implanted cardiac pacing devices, such as the cardiac pacemaker (PM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) [6][7][8]. The CIED consists of complex electronic and ferromagnetic components that can physically interact with the MRI environment [6,8]. Thus, CIED may be harmful to patients because of unpredictable physical movement, potential for burns, or CIED malfunction during an MRI examination [6,8].…”

“…The CIED consists of complex electronic and ferromagnetic components that can physically interact with the MRI environment [6,8]. Thus, CIED may be harmful to patients because of unpredictable physical movement, potential for burns, or CIED malfunction during an MRI examination [6,8]. Furthermore, CIED ferromagnetic components may produce susceptibility artifacts or signal void during MRI [9,10].…”

“…There is a high likelihood that patients with CIED will need MRI examinations over the lifetime of their CIED [11,12]. Due to recent technical developments clinical reports have indicated that MRI can be performed safely under certain specific and controlled conditions, even in patients with CIED [7,8]. CMR may be necessary for diagnosing underlying cardiomyopathy, evaluating arrhythmogenic substrates, and disease progression assessment [3,4,13].…”

“…CMR may be necessary for diagnosing underlying cardiomyopathy, evaluating arrhythmogenic substrates, and disease progression assessment [3,4,13]. The risk to benefit ratio may be significantly affected by the safety and image quality of CMR examination in the CIED setting [8,14]. Thus, when considering the clinical role of CMR in patients with CIED, knowledge of CIED and MRI physics should be obtained to ensure a safe CMR examination.…”