Abstract 11371: Beyond Pacemakers and ICDs: Metallic Devices/Objects in the MRI Environment

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A11371-A11371
• Main Authors: Biederman, Robert W, Gevenosky, Loretta, Williams, Ronald, Lombardi, Richard, Bonnet, Christopher, Shah, Moneal, Doyle, Mark
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

BackgroundSafety concerns limit performance of MRI in patients with metallic devices/objects. Based on the MagnaSafe study and other recent studies, CMS has recently extended their NCD (non-coverage determination) to MRI in legacy pacemakers and ICD’s (PM/ICD) when performed with an appropriate protocol. However, non-PM/ICD devices and abandoned leads may have even less ability to be manipulated to ‘safe’ or ‘safer’ MRI modes and continue to be a contraindication for MRI due to paucity of data. Indeed, CMS expressly treated such devices as taboo in their NCD.HypothesisWe propose that patients with extra-cardiac devices, non-programmable cardiac devices and abandoned leads may undergo MRI similar to patients with legacy PM/ICD’s utilizing a similar protocol.MethodsEighty consecutive patients with implantable loop recorders, abandoned PM/ICD leads and a wide variety of extra-cardiac devices who underwent MR (GE 1.5T, WI) over 10 years (> 95% in the last 3 years) were evaluated. Great care was taken to maintain SAR < 4W/kg to limit induced electromagnetic RF potentials. Additionally, BP, HR, oxygen saturations, as well as, visual monitoring was performed following informed consent with both patient and family members.ResultsThe average MRI was 35±9min for the cohort of 80 patients representing 104 MRI exams. The devices consisted of21 Loops/Linqs, 40 neurostimulators (brain, spinal cord and vagal nerve), 2 bladder stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device and 17 retained/fragmented pacemaker/lCD leads. No intact pacer/ICD comprised this cohort. This population represents 50 neuro/neurosurgical cases, 25 cardiac and 5 musculoskeletal cases. There was no (0%) immediate (peri-MRI exam) morbidity/mortality. Local follow-up data was available in 88% (100% for thoracic imaging) with a mean of 193±486 days (median 17 days) and no (0%) short term device-related complications. Importantly, with careful attention to positioning and scanner sequences, no safety or device issues were encountered in any patient to include those few patients that underwent repeat scans (>1 MRI scan in 10 patients).ConclusionIn this real-world experience, we demonstrate the feasibility of MRI in patients with implantable loop recorders, retained pacemaker/lCD leads and a wide array of extra-cardiac devices when combined with safety precautions similar to legacy non-conditional pacemakers and ICD’s.