Cardiac MRI safety assessment of patients with congenital heart disease and cardiac implantable electronic devices with abdominal pulse generators and epicardial leads

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Reports about cardiac MRI safety and utility in pediatric and adult patients with non-MR-conditional cardiac implantable electronic devices with abdominal pulse generator and epicardial leads remain underreported. Purpose To retrospectively assess safety of cardiac MRI with non-MR-conditional abdominal pulse generators and epicardial leads in pediatric and adult patients with congenital heart disease. Methods Between 04/2020 and 01/2023 25 patients aged 2–32 years (mean 12.7±8.3 years) with abdominal pulse generators and up to three epicardial leads underwent cardiac MRI at 1,5T. SAR was limited to 2W/kg. 19/25 (76%) patients carried pacemakers, 1/25 (4%) ICD, 4/25 (16%) CRTs. 12/25 (48%) of the examinations were performed under general anesthesia. Patients were continuously monitored during cardiac MRI. Results of thresholds, sensing and impedances of the devices were assessed before and after MRI examination. Results In 24/25 (96%) the examination could be finished without significant changes in thresholds, sensing and impedances of the abdominally placed devices. One examination was terminated early because of a major adverse event of heating/abdominal discomfort. Three minor adverse events in three different patients were inability to program back to previous setting (patient 1), alert that the elective replacement indicator (ERI) was reached (patient 2), and significantly elevated impedance (patient 3). Patient 1 and 2 remained in MRI mode and had to be monitored after the MRI examination. Reconfiguration was possible in both patients after 24 hours. Patient 3 had normal results for impedances in the pacemaker query 24 hours after the cardiac MRI examination. Conclusion Our data suggest that cardiac MRI in patients with non-MR-conditional abdominal pulse generators and epicardial leads in pediatric and adult patients with congenital heart disease can be imaged safely in an experienced and multidisciplinary environment. The potential increased risks of MRI in these patients should be balanced against the value of the diagnostic information that can be obtained.