Abstract 2879: Reproducible Safety Protocol for Magnetic Resonance Imaging in Cardiac Rhythm Devices
Background: Magnetic Resonance Imaging (MRI) in patients with Cardiac Rhythm Devices (CRD) has not been approved by the Food and Drug Administration. Recent data suggests MRI as a relative rather than absolute contraindication in CRD patients. We evaluated the feasibility of a safety protocol of CRD patients undergoing MRI, specifically those patients that are pacemaker dependant patients and those with implantable cardioverter defibrillators (ICD).
Methods: Consecutive patients undergoing MRI were included. Those patients whose imaging results would not have made an outcome impact were excluded. The protocol consisted of continuous monitoring during imaging, device interrogation before and after MRI, programming of pacemaker to VOO in pacemaker dependent (PMD) patients and OOO or OVO for non-PMD patients. All tachyarrhythmia detections were disabled. The team consisted of a registered nurse, device company representative and a cardiac physician. All patients with ICDs underwent energy required to defibrillate (ERD)/defibrillation threshold testing (DFTT) and pacing threshold testing post MRI.
Results: A total of 82 MRI’s at 1.5 Tesla were performed in 35 patients. Body structures scanned consisted of brain (35), spine (39) and others (10) were. 15 PMD patients, consisting of 28 total scans were performed and 12 ICD patients, consisting of 28 total scans were performed. All 4 different manufacturers were represented. 71% (25/35) of the patients had multiple same day scans. No device circuitry damage, programming alterations, inappropriate shocks, sensing, failure to pace, threshold or ERD changes were found. No spontaneous or device induced arrhythmias were noted. All thoracic spine images were free of metal artifact and interpretable. No adverse clinical events were reported, even in multiple daily MRI sessions.
Conclusions: A protocol for MRI in CRD patients appears safe, feasible and reproducible, irrespective of CRD status, PMD or defibrillator, or multiple 24-hour scanning sessions. The mentioned protocol addresses early detection of potential complications and establishes a response system for potential device related complications.