Abstract
To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up. With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
Highlights
Magnetic resonance imaging (MRI) has come a long way since the first human MRI scan in 1977 by Damadian et al [1]
We performed a retrospective analysis of consecutive patients with non-programmable cardiac devices (implantable loop recorders, left atrial appendage occlusion device (LAAO), etc.), extra-cardiac devices and abandoned PM/Implantable cardioverter defibrillator (ICD) leads, who underwent MRI (GE 1.5 T, WI) at a single tertiary care center over a span of 13 years (Feb 2006-Mar 2019)
Some portion of the non-pacemakers and implantable cardioverter defibrillators (PM/ICD) metallic device or leads was within the region imaged in at least 38 out of 94 patients and 51 out of 127 scans (Figure 1)
Summary
Magnetic resonance imaging (MRI) has come a long way since the first human MRI scan in 1977 by Damadian et al [1]. The 2008 Joint Commission Sentinel Event Issue 38 regarding MRI safety was sweeping and states “In general, do not bring any device or equipment into the MRI environment unless it is proven to be MR Safe or MR Conditional” [2]. This study overwhelmingly demonstrated safety of 1.5 T in non-conditional PM/ICDs, provided the devices were reprogrammed according to pre-specified protocol. A single center prospective study of 1.5 T MRI in 1509 patients with legacy MR non-conditional PM/ICDs (2103 MRI exams) showed safety of MRI in these patients [12]. We recently published a single center study of 136 patients with CIEDs undergoing MRI demonstrating, the additive value of MRI to diagnosis and management in 97% of the patients without any safety issues [13]. In 30% of the patients, principle diagnosis and subsequent management changed after MRI, demonstrating that beyond safety, a bona fide protocol can catalyze appropriate management supporting more widespread adoption of this approach
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