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

Mascioli, Giosuè; Lucca, Elena; Michelotti, Federica; Tarantino, Luca; Giofrè, Fabrizio; Finamora, Ilaria

doi:10.1371/journal.pone.0244672

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Despite this, the need for MRI has led some groups to scan patients with epicardial systems off Magnetic resonance imaging (MRI) is a powerful imaging modality with excellent softtissue contrast and a non-invasive nature that has become the preferred diagnostic imaging method for various neurological, cardiovascular, and musculoskeletal disorders. It is estimated that at least one MRI scan is necessary during the lifetime of 75% of patients with CIEDs, and many require repeated examination [4][5][6]. The demand for MRI scans is likely even higher in children, as developmental changes necessitate more frequent assessments and alternative imaging modalities with ionizing radiations are more restricted.…”

Section: Introductionmentioning

confidence: 99%

Age Matters: A Comparative Study of RF Heating of Epicardial and Endocardial Electronic Devices in Pediatric and Adult Phantoms during Cardiothoracic MRI

Jiang,

Henry,

Bhusal

et al. 2023

Diagnostics

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This study focused on the potential risks of radiofrequency-induced heating of cardiac implantable electronic devices (CIEDs) in children and adults with epicardial and endocardial leads of varying lengths during cardiothoracic MRI scans. Infants and young children are the primary recipients of epicardial CIEDs, though the devices have not been approved as MR conditional by the FDA due to limited data, leading to pediatric hospitals either refusing the MRI service to most pediatric CIED patients or adopting a scan-all strategy based on results from adult studies. The study argues that risk–benefit decisions should be made on an individual basis. We used 120 clinically relevant epicardial and endocardial device configurations in adult and pediatric anthropomorphic phantoms to determine the temperature rise during RF exposure at 1.5 T. The results showed that there was significantly higher RF heating of epicardial leads than endocardial leads in the pediatric phantom, but not in the adult phantom. Additionally, body size and lead length significantly affected RF heating, with RF heating up to 12 °C observed in models based on younger children with short epicardial leads. The study provides evidence-based knowledge on RF-induced heating of CIEDs and highlights the importance of making individual risk–benefit decisions when assessing the potential risks of MRI scans in pediatric CIED patients.

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Section: Introductionmentioning

confidence: 99%

Age Matters: A Comparative Study of RF Heating of Epicardial and Endocardial Electronic Devices in Pediatric and Adult Phantoms during Cardiothoracic MRI

Jiang,

Henry,

Bhusal

et al. 2023

Diagnostics

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show abstract

“…To exacerbate the problem, a straightforward method to extract epicardial leads does not exist, and children who receive them may become ineligible to receive future MRI scans even if an MR-Conditional device is implanted later on. The barriers to MRI in patients with epicardial leads are concerning considering that 75% of patients with CIEDs are indicated for MRI exams at least once during their lifetime (4) with many requiring repeated examinations (5,6). The demand is likely even higher in children, as developmental changes warrant more frequent assessments and alternative imaging modalities with ionizing radiations are more restricted.…”

Section: Introductionmentioning

confidence: 99%

“…The barriers to MRI in patients with epicardial leads are concerning considering that 75% of patients with CIEDs are indicated for MRI exams at least once during their lifetime (4) with many requiring repeated examinations (5,6). The demand is likely even higher in children, as developmental changes warrant more frequent assessments and alternative imaging modalities with ionizing radiations are more restricted.…”

Section: Introductionmentioning

confidence: 99%

Age and lead configuration matter: A comparative study of RF-induced heating of epicardial and endocardial electronic devices in adult and pediatric anthropomorphic phantoms in 1.5 T MR

Jiang

Henry

Bhusal

et al. 2022

Preprint

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Background: Children with congenital heart defects often have life-sustaining indications for a cardiac implantable electronic device (CIED). In children, these devices are typically sewn to the heart epicardium, but the FDA has never licensed an epicardial system as MR-Conditional due to limited data. Children's hospitals default to either refusing MRI service to a vast majority of pediatric CIED patients or adopting a scan-all strategy based on results from adult studies. We argue that both approaches are flawed, and the risk-benefit decisions should be made on an individual basis. Purpose: To provide evidence-based knowledge on RF-induced heating of CIEDs in children and adults with epicardial and endocardial leads of different lengths. Study Type: Phantom Field Strength/Sequence: 1.5 T. Assessment: 120 clinically relevant epicardial and endocardial device configurations were implemented in adult and pediatric anthropomorphic phantoms. Temperature rise was recorded during RF exposure at 1.5 T. Statistical Tests: Means comparisons were implemented using two-sample t-tests, reliability analysis using interclass correlation coefficient based on a single rating, absolute-agreement, 2-way mixed-effects model. Results: There was significantly higher RF heating of epicardial leads compared to endocardial leads in the pediatric phantom (3.4 ± 3.0 °C vs. 0.6 ± 0.4 °C, p<0.001); however, there was no significant difference in the adult phantom (3.0 ± 3.2 °C vs. 2.0 ± 1.8 °C, p=0.16). Endocardial leads in the pediatric phantom generated significantly less RF heating than in the adult phantom (0.6 ± 0.4 °C vs. 2.0 ± 1.8 °C, p<0.001). Data Conclusion: Body size and lead length significantly affected RF heating. For models based on younger children with short epicardial leads (e.g., 25cm), RF heating up to 12 °C was observed, delivering a cumulative thermal dose previously associated with tissue necrosis. In contrast, RF heating in model based on children with endocardial leads was well below the heating expected from physiologic fever (3 °C).

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The Burden of Cardiac Implantable Electronic Device Checks in the Peri-MRI Setting: The CHECK-MRI Study

Pitman¹,

Ariyaratnam²,

Williams³

et al. 2023

Heart, Lung and Circulation

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

Cited by 3 publications

References 14 publications

Age Matters: A Comparative Study of RF Heating of Epicardial and Endocardial Electronic Devices in Pediatric and Adult Phantoms during Cardiothoracic MRI

Age Matters: A Comparative Study of RF Heating of Epicardial and Endocardial Electronic Devices in Pediatric and Adult Phantoms during Cardiothoracic MRI

Age and lead configuration matter: A comparative study of RF-induced heating of epicardial and endocardial electronic devices in adult and pediatric anthropomorphic phantoms in 1.5 T MR

The Burden of Cardiac Implantable Electronic Device Checks in the Peri-MRI Setting: The CHECK-MRI Study

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