An algorithm for pacing and cardioverting electronic devices undergoing magnetic resonance imaging: The PACED-MRI...

Area of Science:

• Cardiology
• Radiology
• Medical Device Technology

Background:

• Cardiac implantable electronic devices (CIEDs) were historically a contraindication for magnetic resonance imaging (MRI).
• Emerging evidence supports the safety of MRI in select patients with CIEDs when following standardized protocols.
• Institutional protocols are being developed to facilitate safe MRI in patients with CIEDs.

Purpose of the Study:

• To evaluate the efficacy and safety of the PACED-MRI protocol for screening and performing MRI in patients with MR conditional CIEDs.
• To assess a technologist-driven protocol that minimizes the need for direct electrophysiologist supervision.
• To determine if the PACED-MRI protocol can be safely implemented in a clinical setting.

Main Methods:

• A standardized, technologist-driven PACED-MRI protocol was implemented and accessed via an online form.
• Device company representatives utilized the protocol to screen patients with MR conditional CIEDs.
• CIEDs were programmed to MRI mode, interrogated before and after MRI, and adverse events were documented.

Main Results:

• 138 MRI examinations were successfully completed in patients with MR conditional CIEDs (100 pacemakers, 38 ICDs).
• No MRI terminations, deaths, or arrhythmic events occurred during or after the procedures.
• No significant changes in CIED lead parameters were observed post-MRI.

Conclusions:

• The PACED-MRI protocol enables a safe, multidisciplinary approach for MRI in patients with MR conditional CIEDs.
• A technologist-driven protocol can be effectively used for MRI screening without requiring direct electrophysiologist supervision.
• This standardized protocol facilitates increased access to MRI for patients with CIEDs.