PO-03-045 MAGNETIC RESONANCE IMAGING IN PATIENTS WITH MRI UNLABELLED CARDIAC IMPLANTABLE ELECTRONIC DEVICES. ASSOCIATED RISK, SAFETY AND LONG TERM CLINICAL OUTCOMES FROM A SINGLE U.K TERTIARY CENTRE

Abstract

Cardiac implantable electronic devices (CIEDs) that are deemed not to be MR Conditional were historically considered to be a contraindication for MRI. However, a growing body of evidence exists that has shown that MR Unlabelled CIEDs can be scanned safely, providing adequate protocols are followed and associated levels of risk are appropriately recognised. Individualising absolute risk is complex as the number of cases reported with specific generator and lead combinations are small. A comprehensive cardiology-radiology multidisciplinary pathway exists at Royal Stoke University Hospital (RSUH), which considers the associated safety risks involved together with the clinical benefit of the scan. The objective of this study is to determine how many patients with MR Unlabelled CIEDs underwent MRI at Royal Stoke University Hospital, the associated risks, together with the clinical and safety outcomes. A retrospective observational study was performed using local electronic dating reporting systems that were used to review baseline characteristics and clinical outcomes. Descriptive statistics were performed to determine outcomes. 102 patients underwent 132 scans over 72 months with 59% requiring Direct Cardiologist supervision. Inactive, battery depleted CIEDs were noted in 3 patients and 1 patient had an epicardial system implanted in the abdominal region. 1 scan was performed <6weeks prior to implantation and a total of 3 patients underwent MRI when the CIED was at its replacement indicator. 17 patients had reported lead abnormalities, 13 of these having redundant leads and 4 with abnormal lead parameters and pacing dependency. In total, 38% of patients were pacemaker dependant, 57% had non-conditional generators and 9% had reported generator abnormalities. From the calculated pre scan associated risk, 27% were deemed low risk, 48% intermediate, 23% High and 2% Extremely high. From the two who were deemed Extremely high risk, one patient had several redundant leads with an ICD and pacing dependency. Another was pacemaker dependant, with a non-conditional generator at the replacement indicator and an asynchronous mode was unable to be programmed. The clinical question was answered in 96% of patients, with no acute complications and no adverse events reported over a mean follow up of 470days. A comprehensive multidisciplinary clinical pathway has allowed for patients with MR Unlabelled CIEDS to access to MRI for several years, with no reported adverse events.