Implanted Cardiac Devices Pass an MRI Test

February 22, 2017

Implanted Cardiac Devices Pass an MRI Test

  1. Mark S. Link, MD

In a prospective trial of 1500 magnetic resonance imaging scans in patients with “regular” pacemakers or implantable cardioverter-defibrillators, the patients fared well.

  1. Mark S. Link, MD

Conventional pacemakers (PPM) and implantable cardioverter-defibrillators (ICDs) were thought to be an absolute contraindication to magnetic resonance imaging (MRI). However, case reports began to accumulate about inadvertent MRI scans of individuals with devices, without any harm. To systematically explore this possibility, the MagnaSafe Registry, which had partial industry funding, began in 2009 to prospectively enroll patients with non–MRI-conditional devices who clinically needed MRI. Only nonthoracic scans at 1.5 tesla were allowed. In addition, the study had a strict protocol for appropriate programming, including DOO/VOO pacing in pacer-dependent patients with PPMs and inactivation of ICD therapies.

The registry included 1000 MRI scans in patients with PPMs and 500 in those with ICDs. There were no deaths, lead failures, loss of capture, or ventricular arrhythmias. Six episodes of atrial fibrillation or flutter were noted. One ICD device could not be interrogated after MRI and needed immediate replacement. Partial electrical resets were observed six times. Minor changes in lead parameters were occasionally observed.

Comment

Dogma is not fact. In this prospective study of nonthoracic MRI scans in patients with PPMs or ICDs, the overall safety was quite good. These imaging studies were not without risks, but the risks were small. However, this study does not open the door to all MRI scans on all patients. The protocol was strict with regard to patient criteria, necessity of a 1.5-tesla magnet, and appropriate programming both before and after MRI. In addition, Medicare reimbursement for these non–MRI-conditional devices is limited to those in approved clinical trials (https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/MRA_MRI.html).Yet, within these limits, it appears that MRIs can be performed in patients with PPMs or ICDs.

Editor Disclosures at Time of Publication

  • Disclosures for Mark S. Link, MD at time of publication Grant / Research support Unequal Technologies Editorial boards UpToDate; Heart Rhythm Leadership positions in professional societies Heart Rhythm Society (Chair, CME Compliance Committee); American Heart Association (Chair, ACLS Writing Group; Member, Emergency Cardiovascular Care)

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