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Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads

Abstract

Objectives

The European Society of Cardiology Guidelines on cardiac pacing from 2021 allow magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) but do not recommend MRI in patients with epicardial pacing leads. The clinical dilemma remains whether performing an MRI in patients with CIED and epicardial leads is safe. We aimed to evaluate the safety of performing an MRI in patients with CIED and abandoned or functioning epicardial pacing leads.

Methods

We included all adult patients who underwent clinically indicated MRIs with CIED and functioning or abandoned epicardial leads in a single tertiary hospital between November 2011 and October 2019. The data were retrospectively collected.

Results

Twenty-six MRIs were performed on 17 patients with functioning or abandoned epicardial pacing leads. Sixty-nine percent of the MRI scans (18/26) were conducted on patients with functioning epicardial pacing leads. A definite adverse event occurred in one MRI scan. This was a transient elevation of the pacing threshold in a patient with a functioning epicardial ventricular pacing lead implanted 29 years previously. An irreversible atrial pacing lead impedance elevation was detected 6 months after the MRI in another patient; the association with the previous MRI remained unclear. No adverse events were detected in MRIs performed on patients with modern (implanted in 2000 or later) functioning epicardial leads.

Conclusions

MRIs in patients with CIED and modern functioning epicardial pacing leads were performed without detectable adverse events. Further large-scale studies are necessary to confirm MRI safety in patients with epicardial pacing leads.

Key Points

Currently, MRI in patients with cardiac implantable electronic devices (CIEDs) and functioning or abandoned epicardial pacing leads is not recommended.

MRIs in patients with CIED and modern functioning epicardial leads (implanted in 2000 or later) were performed without detectable adverse events in our patient cohort.

Allowing MRI in patients with epicardial pacing leads may significantly improve the diagnostic work-up, especially in specific patient groups, such as patients with congenital heart disease.

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Abbreviations

ccTGA:

Congenitally corrected transposition of the great arteries

CHD:

Congenital heart disease

CIED:

Cardiac implantable electronic device

CRT-P:

Cardiac resynchronization therapy pacemaker

ESC:

European Society of Cardiology

PM:

Pacemaker

RF:

Radiofrequency

TGA:

Transposition of the great arteries

UVH:

Univentricular heart

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Funding

This study has received funding by a HUS Medical Imaging Center research grant and by an Ida Montin Foundation research grant.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Aino-Maija Vuorinen.

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Guarantor

The scientific guarantor of this publication is Touko Kaasalainen.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Abbott (Jarkko Karvonen), Medtronic (Jarkko Karvonen).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because research based purely on documentation or registered materials does not need to be reviewed by the regional ethics committees and informed written consent is not required for research based on purely documentation.

Ethical approval

Institutional Review Board approval was obtained.

Research based purely on documentation or registered materials does not need to be reviewed by the regional ethics committees.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Vuorinen AM, Pakarinen S, Jaakkola I, Holmstrom M, Kivisto S, Kaasalainen T (2019) Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population. Acta Radiol 60:1414–1421. Seven MRIs in seven patients with functioning or abandoned epicardial leads were included in this previous publication and are also included in this study. However, our previous article concentrated on the general safety of MRI in patients with CIED and on the MRI safety protocol. Patients with functioning epicardial pacing leads remained without specific note. This publication concentrates specifically in the subgroup of patients with epicardial pacing leads and adds valuable information in this setting.

Methodology

• retrospective

• observational

• performed at one institution

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Vuorinen, AM., Paakkanen, R., Karvonen, J. et al. Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads. Eur Radiol 32, 3830–3838 (2022). https://doi.org/10.1007/s00330-021-08469-6

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  • DOI: https://doi.org/10.1007/s00330-021-08469-6

Keywords

  • Magnetic resonance imaging
  • Pacemaker, artificial
  • Arrhythmias cardiac
  • Electrodes, implanted