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ICD PATIENT IN THE MRI ENVIRONMENT: SAFETY ASSUMED, LESSONS LEARNED
866 JACC April 5, 2016 Volume 67, Issue 13
Arrhythmias and Clinical EP IMAGING THE PM/ICD PATIENT IN THE MRI ENVIRONMENT: SAFETY ASSUMED, LESSONS LEARNED Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Clinical Care of Patients With Implanted Devices Abstract Category: 18. Arrhythmias and Clinical EP: Devices Presentation Number: 1266-333 Authors: Huma Samar, June Yamrozik, Mark Doyle, Ronald Williams, Geetha Rayarao, Diane V. Thompson, Moneal Shah, Victor Farah, Christopher Bonnet, Robert Biederman, Allegheny General Hospial, Pittsburgh, PA, USA
Background: Pacemaker/ICD imaging is infrequently performed on pts in an MRI environment. When the risk justifies the end, however, consideration to perform ‘high-risk’ scanning can be made on a case-by-case basis but typically with trepidation. However, an important issue has surfaced, “Is the MRI scan adding valuable and irrefutable information to warrant such risk? Methods: Over 4 years, 171 pts were imaged via MRI/CMR (1.5T GE, Milwaukee, WI). Specifically: 33AICD, 13 AICD/PM, 7 retained leads, 118 dual chamber PM. Specific criteria were followed for all pts to objectively define whether final diagnosis provided additional information towards pt care. A checklist of 3 questions was answered following the read by technologist and MRI physician: 1) Did the diagnosis change? 2) Did the MRI provide additional information to existing diagnosis? 3) Did pt management change? If ‘Yes’ was answered to any question, it was considered the MRI scan was of value to pt diagnosis and/or therapy.
Results: All pts completed the procedure with no death, VT/VF or POR. After reviewing the 126 neurology cases as compared to prior studies (CT, angio, EEG or myelogram), 21/126 (17%) MRI’s not only provided additional information but changed original diagnosis and, in turn, course of medical therapy. In 91 pts (72%), MRI provided additional information. In 14/171(11%) pts, MRI only confirmed original diagnosis. The 38 cardiac cases were also compared to prior studies (cath, TEE, TTE or stress) and in 6 pts (16%), CMR provided additional data to change original diagnosis and care. 29/38 pts 76%) provided additional information and 3/38pts (8%) demonstrated no additional information due to ICD artifact.
Conclusions: The use of PM/AICD imaging in MRI remains controversial but technology has improved and increased confidence in its/ use is found. We show that MRI/CMR procedures on carefully selected pts with PM/ICD’s are beneficial and substantially add valuable, often irrefutable information to pt diagnosis and subsequent management. We propose that not only are PM/ICD’s safe when imaged properly but potentially no longer ‘forbidden’ in the MRI environment. Moreover, there can be frequent and marked life-altering and life-saving
Arrhythmias and Clinical EP IMAGING THE PM/ICD PATIENT IN THE MRI ENVIRONMENT: SAFETY ASSUMED, LESSONS LEARNED Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Clinical Care of Patients With Implanted Devices Abstract Category: 18. Arrhythmias and Clinical EP: Devices Presentation Number: 1266-333 Authors: Huma Samar, June Yamrozik, Mark Doyle, Ronald Williams, Geetha Rayarao, Diane V. Thompson, Moneal Shah, Victor Farah, Christopher Bonnet, Robert Biederman, Allegheny General Hospial, Pittsburgh, PA, USA
Background: Pacemaker/ICD imaging is infrequently performed on pts in an MRI environment. When the risk justifies the end, however, consideration to perform ‘high-risk’ scanning can be made on a case-by-case basis but typically with trepidation. However, an important issue has surfaced, “Is the MRI scan adding valuable and irrefutable information to warrant such risk? Methods: Over 4 years, 171 pts were imaged via MRI/CMR (1.5T GE, Milwaukee, WI). Specifically: 33AICD, 13 AICD/PM, 7 retained leads, 118 dual chamber PM. Specific criteria were followed for all pts to objectively define whether final diagnosis provided additional information towards pt care. A checklist of 3 questions was answered following the read by technologist and MRI physician: 1) Did the diagnosis change? 2) Did the MRI provide additional information to existing diagnosis? 3) Did pt management change? If ‘Yes’ was answered to any question, it was considered the MRI scan was of value to pt diagnosis and/or therapy.
Results: All pts completed the procedure with no death, VT/VF or POR. After reviewing the 126 neurology cases as compared to prior studies (CT, angio, EEG or myelogram), 21/126 (17%) MRI’s not only provided additional information but changed original diagnosis and, in turn, course of medical therapy. In 91 pts (72%), MRI provided additional information. In 14/171(11%) pts, MRI only confirmed original diagnosis. The 38 cardiac cases were also compared to prior studies (cath, TEE, TTE or stress) and in 6 pts (16%), CMR provided additional data to change original diagnosis and care. 29/38 pts 76%) provided additional information and 3/38pts (8%) demonstrated no additional information due to ICD artifact.
Conclusions: The use of PM/AICD imaging in MRI remains controversial but technology has improved and increased confidence in its/ use is found. We show that MRI/CMR procedures on carefully selected pts with PM/ICD’s are beneficial and substantially add valuable, often irrefutable information to pt diagnosis and subsequent management. We propose that not only are PM/ICD’s safe when imaged properly but potentially no longer ‘forbidden’ in the MRI environment. Moreover, there can be frequent and marked life-altering and life-saving