MRI in pediatric and congenital heart disease patients with CIEDs and epicardial or abandoned leads

Abstract

Background: Heart Rhythm Society guidelines outlining magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) excluded children and epicardial or abandoned leads due to theoretical risks of harm. Research investigating these risks is lacking. The primary objective of our study is to determine the incidence of adverse events to patients or CIEDs from MRI imaging. The secondary objective is to describe CIED-related artifact on MRI images. Methods: A single-center retrospective review was performed on all patients with CIEDs who underwent 1.5 Tesla MRI between July 2007 and May 2019. We subdivided patients among four cohorts: (1) patients <18 years of age, (2) epicardial leads, (3) abandoned endocardial leads, and (4) abandoned epicardial leads. Descriptive statistics pre-and post-MRI and at follow-up within 1.5 years were conducted. Results: Fifty-four MRIs were performed on 40 patients. Median age was 21.2 years (IQR 12.0-25.0). Eighteen (33%) MRIs contained abandoned leads; 20 (37%) contained epicardial leads. Three patients, one with abandoned epicardial leads and two with abandoned endocardial leads, experienced mild discomfort at the CIED site. One adult with endocardial leads experienced a pause in the heart rate while programmed in a nonpacing mode. No clinically important changes to CIED parameters occurred. Nine MRIs (17%), especially those with functional cardiac imaging, were uninterpretable due to image artifact. Conclusion: In this study, pediatric and adult CHD patients with CIEDs, many with epicardial or abandoned leads, underwent MRIs without clinically significant complications. In some, CIED artifact reduced cardiac MRI image quality due to CIED position.

Radiofrequency‐induced heating of broken and abandoned implant leads during magnetic resonance examinations

“…The presence of abandoned leads during MR examinations has not yet been linked to patient harm in a clinical case, 12‐17 which may be because of the infrequency of such examinations and the fact that many MR scans are done with specific absorption rate (SAR) levels much lower than 2 W/kg. However, the presence of abandoned leads contraindicates MR examination at some sites, 18,19 whereas at others it can be allowed by the expert if mitigating steps are taken (eg, reduced scan intensity or time) 12‐17,20 . To our knowledge, there is no clinical study to date of the effects of leads with broken wires on the safety of MR examination.…”

“…However, the presence of abandoned leads contraindicates MR examination at some sites, 18 , 19 whereas at others it can be allowed by the expert if mitigating steps are taken (eg, reduced scan intensity or time). 12 , 13 , 14 , 15 , 16 , 17 , 20 To our knowledge, there is no clinical study to date of the effects of leads with broken wires on the safety of MR examination.…”

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients

“…However, when attached to a device, the limited data show only a small increase in risk for substantial alterations of the pacing threshold or changes in sensing after MRI. [279][280][281]285,286 Regarding abandoned leads, in vitro data suggest that epicardial leads are more likely to generate heat than transvenous leads; however, small studies evaluating MRIs in patients with both epicardial and transvenous abandoned leads suggest that it can be done safely in the majority of cases. 282,283,[287][288][289] Even so, these studies do not imply lack of an effect on the myocardium underlying the abandoned lead.…”

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: executive summary

“…95 Regarding abandoned leads, in vitro data suggest that epicardial leads generate more heat than transvenous leads; however, small studies of MRIs in patients with both epicardial and transvenous abandoned leads suggest that it can be done safely in the majority of cases. 96 In summary, the data on MRI use in epicardial or abandoned leads are inadequate to provide specific recommendations or absolute contraindications. Acknowledging the sparsity of data, but also the importance of MRI, consideration of the risk/benefit ratio of MRI must be made on a "case by case basis.…”