Abstract 17012: Safety of Magnetic Resonance Imaging in Patients With Non-Transvenous Epicardial and Abandoned Cardiac Implantable Electronic Device Leads

Abstract

Background: Patients with cardiac implantable electronic devices (CIEDs) commonly require magnetic resonance imaging (MRI). Pivotal studies establishing MRI safety in non-MRI-conditional CIEDs excluded patients with nontransvenous epicardial and abandoned leads, which may be higher risk for pro-arrhythmia. Patients with these systems are therefore excluded from national reimbursement coverage and guideline recommendations, and are sparsely reported in the literature. Objective: To describe outcomes of CIED-MRI in patients with epicardial and/or abandoned leads. Methods: We reviewed a prospective registry of CIED-MRIs at a single academic medical center for patients with nontransvenous epicardial leads or abandoned leads, including lead fragments from partial extractions. All patients were scanned on a 1.5T magnet with a standardized protocol including deactivation of tachytherapies (for ICDs), change of pacing mode to asynchronous pacing (if dependent) or off/inhibited (if not dependent), and observation with ECG telemetry and pulse oximetry. The primary outcome was adverse events, defined as any clinical arrhythmia or CIED system malfunction requiring revision procedures. Secondary outcomes included whether the MRI was interpretable and clinically useful. Results: Among 540 CIED-MRIs performed on non-MRI-conditional systems from 6/2014 to 5/2020, 21 MRIs were performed in 15 patients with epicardial or abandoned leads. The Table describes MRI indications and characteristics of CIED systems scanned (most commonly abandoned RA leads, N=10, and abandoned RV leads, N=5). MRIs were predominantly (86%) of the central nervous system. No adverse events were observed during any of the MRI scans, and no CIED systems required revision. All MRIs were found to be interpretable and provided clinically meaningful results. Conclusions: CIED-MRI in patients with epicardial or abandoned leads is safe and provides useful clinical information.