Safety and image quality of cardiovascular magnetic resonance imaging in patients with retained epicardial pacing wires after heart transplantation

Abstract

Background Temporary epicardial pacing wires, implemented in patients during heart transplantation, are routinely removed before discharge. However, in some cases, these wires may remain in situ and are often considered as a contraindication for cardiovascular magnetic resonance (CMR) imaging in the future. Therefore, we aimed to provide data about safety and image quality of CMR in these patients. Methods This is a report on a subpopulation out of 88 patients after heart transplantation that were included in a prospective cohort study and underwent multiple CMR in their post-transplant course. During CMR, patients were monitored by electrocardiogram and all examinations were observed by a physician to document potential adverse events. Additionally, image quality was assessed by an imaging specialist. Results Nineteen of 88 patients included had temporary pacing wires in situ. These patients underwent a total of 51 CMR studies. No major adverse event and only one single, mild sensory event could be documented. All CMR studies showed preserved diagnostic image quality. Temporary pacing wires were visible in 100% of HASTE and cine sequences. In less than 50% of the examinations, temporary pacing wires were also visible in T1 and T2 mapping, short tau inversion recovery (STIR), and late gadolinium enhancement (LGE) sequences, without any impairment of image quality. Conclusions With a low event rate of only one mild adverse event during 51 CMR examinations (2%), CMR appears to be safe in patients with retained temporary epicardial pacing wires after heart transplantation. Moreover, image quality was not impaired by the presence of pacing wires.

Considerations on the Management of Acute Postoperative Ischemia After Cardiac Surgery: A Scientific Statement From the American Heart Association

“…59 It may also be feasible in patients with temporary epicardial pacing wires. 60,61 However, CMR is impractical and infrequently used in the immediate postoperative setting. 53,54,62 New late gadolinium enhancement on CMR during the first 2 weeks after surgery is diagnostic of type 5 myocardial infarction.…”

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

“…Alternatively, these may be cut at the skin after surgery leaving a short length of wire implanted chronically. A study including 51 patients who underwent MRI at 1.0 or 1.5 T with temporary epicardial pacing wires cut short at the skin found no reports of clinical events or symptoms suggesting arrhythmia or other cardiac dysfunction 66–69. Patients with postoperative epicardial pacing wires are fairly common, and given the low risk of complications, this should not be considered a contraindication to MRI scanning.…”