Synopsis

Keywords: Cardiovascular: Cardiac, Transferable skills: Safety, Cross-organ: Pediatric

“Cardiac MRI in Patients with Devices” will discuss the current state of magnetic resonance imaging for patients with implanted devices – focusing on pacemakers. Pediatric specific data will be reviewed, as will Heart Rhythm Society guidelines for imaging adults with devices.

Magnetic resonance imaging (MRI) of patients with pacemakers remains concerning because of possible magnetic field effects on the device. Many pacemaker models are labeled as non-conditional, or contraindicated for MRI, or do not have any specific safety guidelines listed. This study describes our experience with pacemaker function and adverse events in pediatric and young adult patients after clinically indicated MRI scanning at 1.5 Tesla (T). We hypothesized that generator battery voltage, pacemaker lead threshold, and lead impedance would not be altered by MRI. This was a retrospective review of Children's Wisconsin clinical MRI data for all patients with pacemakers scanned between January 1, 2010 and March 31, 2018. Pacemakers were interrogated by the Electrophysiology Team before and immediately after MRI and at outpatient follow up. Twenty-one patients underwent forty-four MRI scans. No significant immediate changes were seen in any pacemaker parameter for any manufacturer/model/lead at the time of MRI. At first clinical follow up post MRI, (median 4.4 months, range 0.2-12.3), battery voltage was reduced (2.78 V pre-MRI versus 2.77 V at follow up, p = 0.02), but there were no other significant changes. No adverse events were noted. Pediatric patients with pacemakers, including those with epicardial leads, can be scanned at 1.5 T safely without alteration in pacemaker function. Using appropriate precautions, pediatric patients with pacemakers can be imaged with MRI.

Acknowledgements

Madeline Bireley, Joshua R. Kovach, Candace Morton, Joseph R. Cava, Amy Y. Pan, and Melodee Nugent

References

Bireley M, Kovach JR, Morton C, Cava JR, Pan AY, Nugent M, Samyn MM. Cardiac Magnetic Resonance Imaging (MRI) in Children is Safe with Most Pacemaker Systems, Including Those with Epicardial Leads. Pediatr Cardiol. 2020 Apr;41(4):801-808. doi: 10.1007/s00246-020-02316-z. Epub 2020 Mar 12. PMID: 32166409.