New MRI Procedures Allow MRI Imaging of the Heart and Thoracic Vessels in Patients with Pacers and Implantable Cardioverter Defibrillators

UH Clinical Update - March 2018

UH Cleveland Medical Center is now offering the ability to provide cardiac magnetic resonance imaging (CMRI) procedures in patients with pacemakers and cardiac implantable electronic devices (CIEDs) previously thought to be unsafe in the MRI environment. MRI scanning of these so called “non-MRI conditional systems” includes all devices that do not meet the MR-conditional labeling.

The term “MRI-conditional” is applied to devices that pose no known hazards in a specific MRI environment under specific device and MRI scanner conditions and is label provided by the Food and Drug Administration (FDA). However, at least 2 million people in the United States have CIEDs in place that have not met these criteria (“non–MRI-conditional”).

“In the case of patients with a non–MRI-conditional cardiac device for whom an MRI has been recommended, in the past, clinicians had to consider the risks of removing a necessary cardiac device versus the drawbacks of utilizing an alternate and potentially less-effective imaging modality,” says Sanjay Rajagopalan, MD, Chief of Cardiovascular Medicine at UH Cleveland Medical Center. “Results from recent prospective studies, has changed our approach to MRI imaging in patients with non–MRI-conditional devices, which appears to suggest that patients aged ?18 years with CIEDs implanted after 2001 and for whom their physician felt a 1.5 tesla MRI scan was clinically indicated could indeed undergo a safe MRI evaluation provided that all patients undergo a protocol driven pre-MRI device interrogation, reprogramming, intra-MRI monitoring, and post-MRI device interrogation and reprogramming.”

This new non-MRI conditional policy has been established following the guidelines of the 2017 Heart Rhythm Society Expert Consensus Statement on Magnetic Resonance Imaging and Radiation Exposure in Patients with Cardiovascular Implantable Electronic Devices.
UH also has new MRI pulse sequences that will minimize artifacts attributable to the metal in CIEDs, making for a better exam.

The UH protocol for patients with CIEDs undergoing an MRI is as follows:

• Physician places an order, which goes to the radiology schedulers.
• Radiology schedulers contact the MRI department. If a patient has a pacemaker or ICD, the device clinic is contacted and a form is completed indicating what type of lead/device the patient has implanted.  The device nurse will determine if the patient’s device is MRI conditional or non-MRI conditional.
• On the day of the patient’s MRI scan, a device nurse checks the patient’s device and programs the patient appropriately. 
• Post-procedure, the device is re-interrogated to ensure that no changes have occurred and that the device is reprogrammed for optimal functioning.

•  Patients with non-MRI conditional devices are continually monitored throughout their MRI scan by a device nurse.

Please contact Judith.Mackall@UHhospitals.org for more information regarding general information on non-MRI conditional devices or electrophysiology aspects . Contact Vikas.Gulani@UHhospitals.org and/or Sanjay.Rajagopalan@UHhospitals.org regarding technical questions pertaining to performance of a cardiac or thoracic MRI.