Recommendations for Imaging Patients With Cardiac Implantable Electronic Devices (CIEDs)

Abstract

Historically, the presence of cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators (ICDs), was widely considered an absolute contraindication to magnetic resonance imaging (MRI). The recent development of CIEDs with MR Conditional labeling, as well as encouraging results from retrospective studies and a prospective trial on the safety of MRI performed in patients with CIEDs without MR Conditional labeling, have led to a reevaluation of this practice. The purpose of this report is to provide a concise summary of recent developments, including practical guidelines that an institution could adopt for radiologists who choose to image patients with CIEDs that do not have MR Conditional labeling. This report was written on behalf of and approved by the International Society for Magnetic Resonance in Medicine (ISMRM) Safety Committee. Level of Evidence 3. Technical Efficacy Stage 1.

Feasibility of cardiac-synchronized quantitative T1 and T2 mapping on a hybrid 1.5 Tesla magnetic resonance imaging and linear accelerator system

“…Specifically for VT patients and occasionally for cancer patients, a cardiac implanted electronic device (CIED) is present to either maintain a sinus rhythm or to receive an ICD shock when a VT episode occurs. CIEDs were historically considered a contraindication for an MRI examination, but in recent years updated guidelines outlined the safe use of MRI in patients with CIEDs [37] . Safety considerations include the reduction of the maximum gradient strength, gradient slew rate, and subject specific absorption rate.…”

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

“…Guidance on MRI scanning of patients with CIEDs from other professional bodies have been considered in the production of these UK recommendations. [1][2][3][4][5][6][7][8] This guidance is not intended to provide a comprehensive literature review, which can be found elsewhere. 1 9 BACKGROUND Between 2016 and 2017, 3.7 million MRI scans were performed in England.…”

“…This guidance aims to support the development of new providers of MRI services to patients with CIED (adults and children) and help the growth of existing services, in order to facilitate equitable provision for those patients in need wherever they may be in the UK. Guidance on MRI scanning of patients with CIEDs from other professional bodies have been considered in the production of these UK recommendations 1–8. This guidance is not intended to provide a comprehensive literature review, which can be found elsewhere 1 9…”

Mri Safety and Management of Patients With Cardiovascular Implantable Electronic Devices: Literature Review and Case Presentation

“…MRI has long been contraindicated in patients with cardiovascular implantable electronic devices (CIED) due to the risk of adverse eff ects through electromagnetic interference (1). Recent developments in engineering have led to the introduction of MRI conditional CIED devices that do not cause signifi cant clinical harm to patients undergoing MRI when specifi c imaging conditions are met (2).…”