More than two million people have CIED or cardiovascular implantable electronic devices like pacemakers, devices vital in keeping many people safe and healthy. People who have pacemakers are among those who would most benefit from an MRI exam. However, common medical knowledge holds that people with CIEDs cannot have magnetic scans because the metals in the devices might interact with MRI parts and endanger the people in or around the scanning room.
Until recently, providers have chosen between finding less-effective imaging or removing cardiac devices from patients who need an MRI. In a recent study published in Radiology: Cardiothoracic Imaging, though, a team of researchers asserts that it is possible to conduct scans safely. Keep reading to learn more about the compatibility between pacemakers and MRIs.
The Research Findings
According to Dr. Sanjaya K. Gupta of Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, their study showed no serious adverse consequences of MRI exams on patients with non-MRI-conditional CIEDs. In previous studies, there is evidence of MRIs being safe for patients with non-MR conditional devices. However, Gupta’s team goes further and identifies the effects of devices on patients who rely on their defibrillator to maintain their heartbeat or ones who have fractured wires no longer connected to the heart.
Their study opens the door for more MRI options for people with pacemakers and ICDs. Though recently-implanted devices are MRI compatible, many people are living with devices that are not.
Gupta’s team even created the PROMeNADe or the Patient Registry of Magnetic Resonance Imaging in Non-Approved Devices. Their database included 532 patients who had 608 MRI exams between September 2015 and June 2019. The figure includes 61 cardiac MRIs, and all of the participants are from groups that had not been incorporated into previous studies.
PROMeNADe makes up the most extensive series of MRI exams among patients who have pacemaker-dependent ICDs. It is also the second-largest one for patients with fractured or abandoned leads and the third-largest series of exams among people with non-compatible devices.
The team evaluated all devices before and after to screen for compatibility with the MRI parts. Also, a nurse closely monitored all the patients’ vital signs as they stayed in the scanner. Pacemaker-dependent patients, meanwhile, turned their devices to asynchronous mode before having their scan. Finally, ICD patients undergoing tachycardia therapies disabled these during the scan.
Patient Follow-Up And Monitoring
Six months after the scan, Gupta’s team followed up with the patients. They found no significant adverse effects from the MRI among pacemaker-dependent ICD patients, those with non-MR conditional devices, or those with abandoned leads. Even for the 14 percent of patients who had multiple scans, the protocol worked well, according to Gupta, and there were no issues with the devices or harm to the patients.
These MRI exams also altered patient care significantly. In a survey of 150 referring physicians, the team learned that non-cardiac and cardiac MRIs changed the suspected diagnosis of a patient 25 percent of the time. It also altered the prognosis of 26 percent of participants. The scans also changed patients’ medical or surgical treatment plans 42 percent of the time.
Gupta noted that their study had limitations; for example, they had no data on patients who had their devices installed within six weeks of the exam. Also excluded are patients who required recent defibrillator therapy, hemodynamically unstable patients, or patients who need constant arrhythmia detection.
Despite the limitations, results like these are still helpful to CIED-dependent individuals as a whole. People who could benefit from MRI scans and fit the criteria Gupta and his team used can undergo a scan without fearing for their safety. Also, the team hopes that their research will support the FDA’s indications for the compatibility of devices.
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