Cardiology Letters 2020, 29(5):285-292

Management of patients with cardiac implantable electronic devices and diagnostic indication for magnetic

Šašov M¹, Neuschl V³, Margitfalvi P¹, Kaliská G^{2, 4}, Hatala R^{1, 2}

¹ Oddelenia arytmií a kardiostimulácie Národný ústav srdcových a cievnych chorôb, a. s. v Bratislave

² Klinika kardiológie a angiológie LF SZU v Bratislave

³ Inštitút zobrazovacej diagnostiky - MR IZD, s.r.o., Trnava

⁴ Oddelenie arytmií, Stredoslovenský ústav srdcových a cievnych chorôb, a. s., Banská Bystrica, Slovenská republika

Diagnostic indications for magnetic resonance imaging (MRI) are rapidly expanding and continue to present a challenge in patients with cardiac implantable electronic devices (CIEDs - mainly pacemakers or ICDs). Most currently implanted CIEDs are compatible with MRI environment (MRI conditional devices) and the procedure is safe when instructions from the manufacturer are followed. These instructions are usually realized by specialized cardiologists of the implanting centre in collaboration with radiologists. Nevertheless, it is important also for a wider community of medical specialists not to consider mere presence of CIED as contraindication to MRI scan and at the same time to know its risks and limitations. For a safe MRI procedure it is important to verify the exact type of implanted CIED, to check its electric parameters, to temporarily reprogramme it before MRI scan, to monitor the patient in the MRI environment and finally to return to original device programming. MRI is contraindicated in patients with fragmented and abandoned electrodes as well as in those with epicardial electrodes. MRI imaging is not necessarily contraindicated even for conventional CIEDs (i.e. MRI non-conditional), but it is of utmost importance to individually assess the risks and benefits and answer the following questions: * Is the diagnostic value of the planned MRI invaluable? * Does such information critically impact the patient's future management? (e.g. search for metastases in cancer patients etc.) Patients with older conventional CIEDs (longevity of such devices frequently exceeds 10 years) together with pacing-dependent patients are at highest risk for MRI scan. For these patients, MRI systems with field intensity exceeding 1.5 T must not be used. However, real world data based on observations of thousands of patients confirm that also "MRI non-conditional" CIEDs can be safely used without fatal complications or triggered shocks if certain conditions are fulfilled. This review reflects up-to-date technical knowledge together with available evidence in this highly specialized interdisciplinary field. It presents basic practical overview of the topics and addresses mainly cardiologists and radiologists.

Keywords: electronic devices; pacemaker; ICD; magnetic resonance imaging

Published: May 1, 2020  Show citation