Cardiac MRI with implanted devices including pacemakers and retained leads: Adult and pediatric experience-Congenital CMR Case Conference final 2021-10-13

Video Transcription

Video Summary

The SCMR Congenital Conference focused on MRI safety in patients with implanted cardiac devices, especially pacemakers and ICDs, and how programs can safely scan these patients. Dr. Harold Litt described the main risks: inappropriate ICD shock detection, pacing inhibition, device resets, and rare arrhythmias during MRI. He emphasized that scans require careful pre- and post-scan device interrogation, appropriate programming, continuous supervision, and immediate removal from the magnet if a patient develops VT/VF. He reviewed evidence supporting MRI in non-conditional devices, including large studies and Penn’s experience with more than 6,000 scans over 17 years, even in complex cases such as abandoned or epicardial leads.<br /><br />Dr. Margaret Salmon then discussed pediatric experience at Children’s Wisconsin. She reviewed the growth of MR-conditional devices, the high likelihood that pacemaker patients will need MRI, and the limited but reassuring pediatric literature. Her institution’s retrospective study found no clinically meaningful changes in pacemaker function and no adverse events, including in many children with epicardial leads. She concluded that MRI can be performed safely in children when benefits outweigh risks and standardized protocols are followed.<br /><br />The session ended with discussion of anesthesia, artifact reduction, wideband imaging, and the importance of collaboration and expanding pediatric MRI access for device patients.

Keywords

MRI safety

cardiac devices

pacemakers

ICDs

device interrogation

non-conditional devices

pediatric MRI

epicardial leads

wideband imaging