"CMR in Patients with Pacemakers/ICD" - Case-Based Webinar (CME)-Video

Video Transcription

Video Summary

The webinar, part of the SCMR Case-Based Educational Series, focused on the safety and clinical value of cardiac MRI in patients with pacemakers, ICDs, and other cardiac implantable electronic devices (CIEDs). Dr. Syed reviewed device types, MRI labeling (MR-conditional vs. legacy/non-conditional), major risks such as device reset, lead heating, and pacing interference, and how careful patient selection and pre-scan device programming reduce complications. He emphasized that 1.5T scanners are preferred for legacy devices and that chest X-rays help identify abandoned or epicardial leads and anticipate artifact.<br /><br />Clinical cases illustrated how MRI can change management. In one patient with recurrent ventricular tachycardia and an ICD, MRI showed findings concerning for cardiac sarcoidosis; PET and biopsy confirmed active sarcoid, leading to immunosuppressive therapy rather than ablation. Dr. Kino presented cases showing that even with pacemakers, MRI can characterize cardiac masses: one LV mass proved to be fibroma rather than thrombus, and another case revealed a diffuse epicardial fatty tumor/lipoma.<br /><br />The discussion highlighted practical scanning strategies, including using gradient echo when SSFP is degraded by artifact, and the value of wideband LGE sequences for reducing device-related hyperintensity artifacts. The speakers also noted that pacemakers often cause less artifact than ICDs, while subcutaneous ICDs remain especially challenging. Overall, the message was that CIEDs are not an absolute contraindication to cardiac MRI, and with proper protocols, MRI can be performed safely and provide crucial diagnostic information.

Keywords

cardiac MRI

CIEDs

pacemakers

ICDs

MR-conditional

device programming

lead heating

cardiac sarcoidosis

wideband LGE

artifact reduction