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MRI using defined protocol is safe even in patients with older implanted cardiac devices
Clinical Question
Is magnetic resonance imaging using a carefully defined protocol safe for patients with older implanted cardiac devices?
Bottom line
Adverse events from magnetic resonance imaging (MRI) using a carefully defined protocol are rare and do not result in clinical harms for patients with older implanted cardiac devices. Only 1 in 2103 scans resulted in the need to replace the device and there were no clinically significant arrhythmic events. 2b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Inpatient (any location)
Synopsis
This study reports the outcomes in 1509 patients with a "legacy" (ie, non-MRI approved) pacemaker or implantable defibrillator who underwent 2103 MRI examinations at Johns Hopkins University. The radiologists used an MRI protocol they developed, as well as a clinical protocol administered by a nurse that involves reprogramming the device to asynchronous mode for patients with intrinsic bradycardia and to an inhibited mode for all other patients. The MRIs used a 1.5 Tesla magnet and took place over the period from 2003 to 2015. The median age of participants was 69 years, 36% were women, 58% had a pacemaker, and 42% had an implantable defibrillator. In 2103 examinations, there were only 9 adverse events in which the device experienced a power-on reset (making it temporarily inactive). However, no patient experienced any serious clinical adverse event, with the excpetion of a single patient who required replacement of his pacemaker. A limitation of this study is that they had long-term (6-month) follow-up for only approximately 80% of patients.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Notre limitation localement c’et le refus systématique par le département de radiologie de faire une IRM si le pacemaker est plus vieux. Cette étude est encourageante mais il faudrait qu’elle soit acceptée par tous les radiologues!
This study is good information I wonder that apply to other brands as well, we use protocol but it is time consuming , and cardiologist involved, some of my patient expressed that they horrible experiences but I could not determine if was due pacemaker or claustrophobia , according to cardiologist there was no cardiac event.
good poem
with 20% lost to follow up if intent to treat was used, this could have different outcomes.