Prospective evaluation of the utility of magnetic resonance imaging in patients with non‐MRI‐conditional pacemakers and defibrillators

Abstract

Background Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients. Methods This is a single‐center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database. The outcomes were classified as aiding in diagnosis, treatment, or both for the patients attributable to the MRI. We then assessed the incidence of adverse effects (AE) when the MRI was performed. Results In 668, MRIs performed on 479 patients, only 13 (1.9%) MRIs did not aid in the diagnosis or treatment of the patient. Power‐on reset events without clinical sequelae in three scans (0.45%) were the only AE. The probability of an adverse event happening without any benefit from the MRI scan was 1.1 × 10−4. A maximum benefit in diagnosis using MRI was obtained in ruling out space‐occupying lesions (121/185 scans, 65.4%). Scans performed in patients for elucidating answers to queries in treatment were most frequently done for disease staging at long term follow‐up (167/470 scans, 35.5%). Conservative treatment (184/470 scans, 39%) followed by medication changes (153/470 scans, 28.7%) were the most common treatment decisions made. Conclusions The utility of MRI in patients with non‐MRI‐conditional CIEDs far outweighs the risk of adverse events when imaging is done in the context of a multidisciplinary program that oversees patient safety.

SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

“…Other small series in pediatric patients have reported no adverse events, although the sizes of those series remain small: 5 to 40 patients [42] , [137] , [138] , [139] , [140] . A few larger series reporting primarily adult outcomes included a small number of pediatric patients [44] , [135] , [141] .…”

“… A risk-benefit discussion, preferably with documented informed consent, should be obtained for imaging of non-MR-conditional systems or those with retained leads. [42] , [137] , [138] , [139] , [140] , [141] With fewer than 100 pediatric patients in the literature, high-volume pediatric centers continue to obtain informed consent for non-MR-conditional systems Sedation and general anesthesia increase the risks of undetected lead heating and should be avoided in children when possible [41] , [42] Individual patients have reported discomfort during MRI scans, without objective evidence for harm. Epicardial leads that cannot be assessed with an active pulse generator should be evaluated as if they were fractured.…”

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

“…There should be a clear benefit of MRI over other imaging modalities which should translate into significant diagnostic and/or therapeutic changes for the patient. A recent study done with non‐conditional devices has shown that the clinical benefit (in terms of diagnosis and/or treatment decision) was provided in 98.1% of the MRI scans 129 2Check whether the system is MRI conditional or not …”