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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 371] [Impact Index Per Article: 371.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Pitman BM, Ariyaratnam J, Williams K, Evans M, Reid-Smith N, Wilson L, Teo K, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. The Burden of Cardiac Implantable Electronic Device Checks in the Peri-MRI Setting: The CHECK-MRI Study. Heart Lung Circ 2023; 32:252-260. [PMID: 36443175 DOI: 10.1016/j.hlc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most modern cardiac implantable electronic device (CIED) systems are now compatible with magnetic resonance imaging (MRI) scans. The requirement for both pre- and post-MRI CIED checks imposes significant workload to the cardiac electrophysiology service. Here, we sought to determine the burden of CIED checks associated with MRI scans. METHODS We identified all CIED checks performed peri-MRI scans at our institution over a 3-year period between 1 July 2017 to 30 June 2020, comprising three separate financial years (FY). Device check reports, MRI scan reports and clinical summaries were collated. The workload burden was determined by assessing the occasions and duration of service. Analysis was performed to determine cost burden/projections for this service and identify factors contributing to the workload. RESULTS A total of 739 CIED checks were performed in the peri-MRI scan setting (370 pre- and 369 post-MRI scan), including 5% (n=39) that were performed outside of routine hours (weekday <8 am or >5 pm, and weekends). MRIs were performed for 295 patients (75±13 years old, 64% male) with a CIED (88% permanent pacemaker, and 12% high voltage device), including 49 who had more than one MRI scan. The proportion of total MRI scans for patients with a CIED in-situ increased each FY (from 0.5% of all MRIs in FY1, to 0.9% in FY2, to 1.0% in FY3). The weekly workload increased (R2=0.2, p<0.001), but with week-to-week variability due to ad hoc scheduling (209 days with only one MRI vs 78 days with ≥2 MRIs for CIED patients). The projected annual cost of this service will increase to AUD$161,695 in 10 years for an estimated annual 546 MRI scans for CIED patients. CONCLUSIONS There is an increasing workload burden and expense associated with CIED checks in the peri-MRI setting. Appropriate budgeting, staff allocation and standardisation of automated CIED pre-programming features among manufacturers are urgently needed.
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Affiliation(s)
- Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/pitmabm
| | - Jonathan Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kerry Williams
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michelle Evans
- Southern Area Local Health Network, Adelaide, SA, Australia
| | - Nicole Reid-Smith
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lauren Wilson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen Teo
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Glenn D Young
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Goodwin E, Fogelson B, Cox JW, Mahlow WJ. An algorithm for pacing and cardioverting electronic devices undergoing magnetic resonance imaging: The PACED-MRI protocol. Magn Reson Imaging 2023; 96:44-49. [PMID: 36441043 DOI: 10.1016/j.mri.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cardiac implantable electronic devices (CIEDs) have traditionally been a contraindication for magnetic resonance imaging (MRI). However, there is an increasing amount of literature to suggest that MRI can be safely performed in select patients with pacemakers and implantable cardioverter defibrillators by following a standardized protocol. We created an institutional protocol, made accessible as an online form, that is primarily technologist-driven and does not require direct electrophysiologist supervision. The purpose of this study was to evaluate the PACEDMRI protocol for screening and completing MRI in patients with MR conditional CIEDs. SUBJECTS AND METHODS After the implementation of our standardized PACED-MRI protocol, patients with MR conditional CIEDs who were referred for MRI were included in the study. On the day of the MRI, the device company representative utilized our protocol accessed through PACEDMRI.com. If all parameters and criteria within the protocol were met, the examination proceeded. The device representative programed the CIED to the appropriate mode for MRI as instructed by the PACED-MRI protocol. CIED interrogation was performed immediately before and after MRI. The on-call electrophysiology nurse practitioner was notified only if the protocol instructed the team to not proceed with MRI. CIED programming changes, malfunctions, and intraprocedural events were documented. Additionally, any adverse outcomes were recorded including peri-MRI symptom onset, arrhythmia, and death. RESULTS One hundred thirty-eight MRI examinations were performed on patients with MR conditional CIEDs (100 pacemakers: 38 implantable cardiac defibrillators). There was no incidence of symptom onset requiring early termination of the MRI, death, or arrhythmic events during or after MRI. No significant changes in lead parameters, including sensing amplitudes, lead thresholds, or lead impedances were noted on post-MRI device interrogation. Out of the 138 completed MRIs, the on-call electrophysiology provider was notified on one, non-urgent occasion. CONCLUSION The implementation of the standardized, technologists-driven PACED-MRI protocol allowed for a multidisciplinary approach to MRI for patients with MR conditional CIEDs. This study demonstrates that the PACED-MRI protocol can be used for patients with MR conditional CIEDs undergoing MRI without the need for direct electrophysiologist supervision.
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Affiliation(s)
- Elliott Goodwin
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - Benjamin Fogelson
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James W Cox
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - William J Mahlow
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Siddamsetti S, Shinn A, Gautam S. Remote Programming of Cardiac Implantable Electronic Devices: A Novel Approach to Program Cardiac Devices for Magnetic Resonance Imaging. J Cardiovasc Electrophysiol 2022; 33:1005-1009. [PMID: 35243710 DOI: 10.1111/jce.15434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic Resonance imaging (MRI) in patients with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIEDs in patients undergoing MRI scan. METHODS We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from the 2090 Medtronic programmer over the CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 patients who underwent RP of CIEDs for MRI. Outcomes analyzed were successful completion of RP sessions and time saved per scan. RESULTS Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any patient. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Time saved per scan was estimated to be 28 +/-10 minutes. CONCLUSIONS Remote programming of CIEDs for MRI scans is a safe and effective strategy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sisir Siddamsetti
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Alexander Shinn
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
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Burke RE, Marang-van de Mheen PJ. Sustaining quality improvement efforts: emerging principles and practice. BMJ Qual Saf 2021; 30:848-852. [PMID: 34001651 DOI: 10.1136/bmjqs-2021-013016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Robert E Burke
- Section of Hospital Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA .,Center for Health Equity Research and Promotion (CHERP), Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsyllvania, Philadelphia, PA, USA
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
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Pieri C, Bhuva A, Moralee R, Abiodun A, Gopalan D, Roditi GH, Moon JC, Manisty C. Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators. Open Heart 2021; 8:e001598. [PMID: 34031214 PMCID: PMC8149430 DOI: 10.1136/openhrt-2021-001598] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes. METHODS Retrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)). RESULTS Responses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units' scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED-MRI scans). CONCLUSIONS Provision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.
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Affiliation(s)
- Christopher Pieri
- Institute of Health Sciences, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Anish Bhuva
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Russell Moralee
- Department of Radiology, Imperial College London, London, UK
| | - Aderonke Abiodun
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Deepa Gopalan
- Department of Radiology, University of Glasgow, Glasgow, UK
| | - Giles H Roditi
- Department of Cardiovascular Imaging, Barts Heart Centre, London, Greater London, UK
| | - James C Moon
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Charlotte Manisty
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
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Deshpande S, Kella D, Padmanabhan D. MRI in patients with cardiac implantable electronic devices: A comprehensive review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:360-372. [DOI: 10.1111/pace.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Danesh Kella
- Department of Cardiology Piedmont Heart Institute Atlanta Georgia USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
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Augusto JB, Manisty C. Breaking down the barriers: Re-evaluating risk of MRI in patients with cardiac implantable electronic devices via collaborative practice. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Augusto JB, Manisty C. Breaking down the barriers: Re-evaluating risk of MRI in patients with cardiac implantable electronic devices via collaborative practice. Rev Port Cardiol 2020; 40:53-55. [PMID: 33239256 DOI: 10.1016/j.repc.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- João B Augusto
- Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal; Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, London, UK.
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Ryan JW, Murray AS, Gilligan PJ, Bisset JM, Nolan C, Doyle A, Emerson B, Galvin JM, Murray JG. MRI safety management in patients with cardiac implantable electronic devices: Utilizing failure mode and effects analysis for risk optimization. Int J Qual Health Care 2020; 32:431-437. [PMID: 32578847 DOI: 10.1093/intqhc/mzaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/13/2020] [Accepted: 06/20/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Cardiac implantable electronic devices (CIEDs) are increasing in prevalence. Exposing patients with CIEDs to magnetic resonance imaging (MRI) can lead to adverse outcomes. This has led certain radiology departments to not accept MRI referrals related to patients with CIEDs. Patients with MR-conditional CIEDs can be safely scanned under specific conditions. Our institution has accepted such referrals since 2014. The aim of this study was to systematically identify and reduce risk in our CIED-MRI protocol using failure mode and effects analysis (FMEA). METHODS A multidisciplinary FMEA team was assembled and included senior stakeholders from the CIED-MRI protocol. A process map was constructed followed by risk analysis and scoring. Targeted interventions were formulated and implemented; high-risk failure modes were prioritized. A new process map and protocol were drafted and repeat risk analysis was performed. Monitoring and re-evaluation of the CIED-MRI pathway were instigated at departmental quality assurance (QA) meetings. RESULTS Interventions included direct CIED characterization using wireless technology pre-MRI, CIED programming and reprogramming in the MRI suite before and immediately after MRI reducing device downtime and continuous patient monitoring during MRI by a cardiac physiologist. The cumulative risk priority number (RPN) decreased from 1190 pre-FMEA to 492 post-FMEA. DISCUSSION Despite the risk of exposing CIEDs to the MR environment, patients with MR-conditional CIEDs can be safely scanned with an appropriate multidisciplinary support. We found FMEA an indispensable tool in identifying and minimizing risk with no adverse events recorded since FMEA recommendations were implemented.
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Affiliation(s)
- James W Ryan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | | | | | - Chris Nolan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Audrey Doyle
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Barry Emerson
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | - John G Murray
- Mater Private Hospital, Eccles Street, Dublin, Ireland
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Bhuva AN, Moralee R, Moon JC, Manisty CH. Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. Eur Radiol 2019; 30:1378-1384. [PMID: 31776746 PMCID: PMC7033076 DOI: 10.1007/s00330-019-06449-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.
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Affiliation(s)
- A N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute for Cardiovascular Science, University College London, London, UK.
| | - R Moralee
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - J C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
| | - C H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
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Sichere MRT-Untersuchung bei Patienten mit Herzschrittmacher und ICD. Radiologe 2019; 59:885-893. [DOI: 10.1007/s00117-019-0567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cunqueiro A, Lipton ML, Dym RJ, Jain VR, Sterman J, Scheinfeld MH. Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists. Clin Radiol 2019; 74:912-917. [PMID: 31431253 DOI: 10.1016/j.crad.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Pacemakers and implantable cardioverter defibrillators are commonly encountered in clinical practice, and entails special consideration when magnetic resonance imaging (MRI) is required. It is estimated that 50-75% of patients with cardiac implantable electronic devices (CIED) will have an indication for MRI during their lifetime. Radiologists may want to recommend MRI or may be consulted about the need to perform MRI in a patient with a CIED, at which point they may need to approve or at least provide guidance as to whether MRI may be performed safely. Even in situations where final clearance will not be provided by the radiologist, he or she can provide valuable information by reviewing radiographs and determining (a) whether a device is MRI-conditional and MRI may ultimately be permitted, (b) is not MRI-conditional and MRI using the standard workflow will therefore not be approved, or (c) when additional information will clearly be required. CIED identification and verification of leads can be accomplished through review of the medical record and/or evaluation of a chest radiograph. In patients with MRI-conditional CIEDs (as well as with legacy CIEDs in those institutions that perform MRI of these patients), specific imaging protocols must be adhered to in order to prevent death or injury to the patient or damage to the device. In this update, we provide details regarding the above topics and provide an algorithm for integrating this information into a clinical workflow to efficiently triage patients with CIEDs who are being considered for MRI.
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Affiliation(s)
- A Cunqueiro
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M L Lipton
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neuroscience, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R J Dym
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - V R Jain
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Sterman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M H Scheinfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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