MRI safe in patients with implantable cardiac devices with abandoned leads

CHICAGO — When performed with careful monitoring, MRI is a safe option for patients with cardiac electronic implantable devices and abandoned leads, according to a presentation at the Heart Rhythm Society Annual Scientific Session.

Deepak Padmanabhan , MD , and Paul Friedman, MD, both from the Mayo Foundation for Medical Education and Research, and colleagues reviewed a cohort of 964 patients with cardiac electronic implantable devices who underwent MRI between 2008 and 2016 and assessed troponin I in addition to continuous real-time monitoring and device preprogramming to screen for myocardial damage.

“Currently, 2 million patients in the United States have implanted devices. Under current estimates, 50% of these will need an MRI after device implantation,” Padmanabhan told Cardiology Today. “MRI-conditional devices have to have the whole system to be conditional and not just parts of it, so these patients would never truly have an `MRI-safe’ device in the presence of these abandoned leads. Therefore, there is an urgent need for a solution to this problem.”

Of the 964 patients, 57 (median age, 66 years; 63.2% men) underwent 70 MRI scans with 63 abandoned leads from cardiac electronic implantable devices in place.

During the scan, there was no evidence of implantable cardiac device dysfunction, arrhythmias or pain, Padmanabhan and colleagues reported.

Paired troponin samples could be evaluated in 35 patients undergoing 39 MRI scans. Mean difference in troponin I between pre-imaging and post-imaging was 0.002 ± 0.006 ng/mL, according to the researchers.

Adjustment for total number of leads per patient, total number of ICD coils, location of abandoned lead and type of lead fixation did not change the results.

“We feel that this study shall help physicians utilize MRI and ease any safety concerns in this subgroup of patients. We believe that if the proper precautions are taken, the benefit of this impressive diagnostic modality can be extended to them safely,” Padmanabhan said in an interview. “Hopefully we can change the recommendation of guideline committees in the long run to include these patients so that it can be adopted on a larger scale across the world.” – by Dave Quaile

Reference:

Padmanabhan D, et al. Abstract C-PO01-27. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 10-13, 2017; Chicago.

Disclosure: Padmanabhan reports no relevant financial disclosures.