PE-452787-2 A MULTICENTER RETROSPECTIVE EVALUATION OF MAGNETIC RESONANCE IMAGING IN PEDIATRIC AND CONGENITAL HEART DISEASE PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES

Abstract

Guidelines addressing magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) provide algorithms for imaging pediatric and congenital heart disease (CHD) patients. Guideline acceptance varies by institution; some continue to exclude patients with CIEDs from MRI. Citing insufficient data, guidelines do not support routine MRI scans in patients with epicardial or abandoned leads, common in pediatric and CHD patients. We sought to determine the incidence of MRI-related complications in pediatric and CHD patients with CIEDs, including epicardial and/or abandoned leads. A multicenter retrospective review included all patients with a CIED who underwent any MRI between 7/2007 and 7/2022 at participating congenital cardiac centers. The primary outcome was any patient adverse event, CIED malfunction, or clinically significant CIED change after MRI, defined as pacing lead threshold increase >0.5 V with change in output, P- or R- wave amplitude decrease >50% with change in sensitivity, or impedance change >50%. Adverse events among MRI-conditional and non-conditional CIEDs were compared. Across 14 institutions, 314 patients underwent 389 MRIs; median age was 18.8 [IQR 11.3 – 31.4, range 0.1-77.4] years. There were 288 (74%) pacemakers, 87 (22%) ICDs, and 14 (4%) abandoned leads only. Most were MRI non-conditional (287, 74%); 201 (51%) had epicardial leads, and 66 (17%) had abandoned leads. No MRI-related deaths, sustained symptoms, or CIED malfunction occurred. On 8 (2.1%) occasions, symptoms of warmth, tingling, or pain occurred; 5 (63%) involved abandoned lead(s), and 2 (25%) resulted in MRI termination. Other indications for MRI termination were poor image quality (13, 3.3%), claustrophobia (1, 0.2%), and incorrect device programming (1, 0.2%). A pacing capture threshold change occurred in 0.3% (1/359) and 1.8% (6/335) of patients post-MRI and at follow-up (median 36 [IQR 1-73] days after MRI). An impedance change occurred in 1.4% (5/359) and 1.2% (4/335) of patients post-MRI and follow-up. Impedance changes primarily occurred in MRI non-conditional CIEDs. Other adverse events were similar among MRI-conditional and non-conditional CIEDs. MRIs can be performed in pediatric and CHD patients with CIEDs, including non-conditional CIED systems, with rare, minor CIED changes but no other complications. Our data provide evidence that patients with epicardial and/or abandoned leads can safely undergo MRI imaging.