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Safety of magnetic resonance imaging in patients with compatible cardiac implantable electronic devices: a safety and acute performance evaluation
Session:
Sessão de Posters 55 - RM Cardíaca
Speaker:
Mário Martins Oliveira
Congress:
CPC 2024
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Cartazes
FP Number:
---
Authors:
Mário Martins Oliveira; Tomás Gaspar; Luis Brandao; Sofia Almeida; João Mesquita; Ana Trindade; Pedro Valente; Tiago Muxagata; Susana Castela; Rui Placido; João Augusto; Pedro Matos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:"Cambria",serif"><span style="color:black">Magnetic resonance imaging (MRI) is a growing valuable imaging modality. It is estimated that a large majority of patients (P) with cardiovascular implantable electronic devices (CIEDs) will have an indication for MRI. MRI-conditional CIEDs have demonstrated safety during MRI scanning, yet many physicians are still reluctant to refer these P to MRI. In this study, we aimed to evaluate the acute impact of an MRI session on the functional parameters indicators of CIED performance. <strong>Methods:</strong> Our institution protocol included: confirmation of MRI compatibility, time since implantation > 6 weeks and exclusion of abandoned leads, followed by interrogation of CIED parameters - atrial and ventricular sensing, capture threshold, pacing impedance and battery voltage in all P, and also shock impedance in cardioverter-defibrillators (ICD). The next stage looked at pacing dependency (if yes, the PM was programmed in VOO/DOO; if no, it was programmed in VOO/DOO mode or off-pacing – OVO/ODO). In ICD P, pacing programmed like PM P and with tachyarrhythmia therapies turned off. MRI protection was enabled. P underwent MRI sessions while monitoring symptoms, ECG and blood oxygen levels. After MRI scan, all parameters were (re)checked, EGMs analyzed (looking for noise detection) and original programming settings were restored. <strong>Results:</strong> Between January/2022 and December/2023, 122 consecutive P with MRI-compatible CIEDs were submitted to a MRI scan in our institution – 99 men, mean age 73,4 years (42-92). Ninety-eight patients had a pacemaker (73,5% DDDR), 15 an ICD, and 9 a CRT (P/D). CIEDs manufacturers were: Medtronic (n=39), Abbott (n=30), Biotronik (n=25), Boston Scientific (n=25), and Microport (n=3). There was no generator/lead(s) brands mismatch. P underwent 37 thoracic (including 11 cardiac) and 85 non-thoracic MRI, all performed with a magnetic field strength of 1,5 Tesla (GE Voyager equipment). Table I shows the comparison between pre- and post-MRI scan CIEDs parameters. There were no statistically significant differences regarding lead parameters or battery voltage. One P developed atrial fibrillation with rapid ventricular rate during MRI, without clinical consequences. No other symptoms or clinically adverse events were reported. </span></span></span><span style="background-color:white"><span style="font-family:"Cambria",serif"><span style="color:#212121">There was a notable change in device parameters (<u>></u>50% change from baseline) immediately after MRI for P-wave amplitude in 10% of the P, R-wave amplitude in 5%, atrial or ventricular capture threshold in 8% and lead impedance in 5%, which were in the range of normal values and transitory. There were no variations in shock impedance and no noise was detected in ICD P. <strong>Conclusions:</strong> This study demonstrates that MRI scans performed in P with MRI-compatible CIEDs under a strict protocol and with appropriate monitoring can be done safely.</span></span></span></span></span></span></p>
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