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European Radiology
Published in: European Radiology 3/2020

Open Access 01-03-2020 | Magnetic Resonance Imaging | Cardiac

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

Authors: A. N. Bhuva, R. Moralee, J. C. Moon, C. H. Manisty

Published in: European Radiology | Issue 3/2020

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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.
Literature
1.
Sutton R, Kanal E, Wilkoff BL et al (2008) Safety of magnetic resonance imaging of patients with a new Medtronic EnRhythm MRI SureScan pacing system: clinical study design. Trials. 9(1):68PubMedPubMedCentralCrossRef
2.
3.
4.
Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 389(10071):815–822PubMedCrossRef
5.
Bradshaw PJ, Stobie P, Knuiman MW, Briffa TG, Hobbs MST (2014) Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population. Open Heart 1(1):e000177PubMedPubMedCentralCrossRef
6.
Kalin R, Stanton M (2005) Current clinical issues for MRI scanning of pacemaker and defibrillator patients. Pacing Clin Electrophysiol 28(4):326–328PubMedCrossRef
7.
Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A (2018) MRI in patients with cardiac implantable electronic devices. Radiology. 289(2):281–292PubMedCrossRef
8.
Lohrke J, Frenzel T, Endrikat J et al (2016) 25 years of contrast-enhanced MRI: developments, current challenges and future perspectives. Adv Ther 33(1):1–28PubMedPubMedCentralCrossRef
9.
Ainslie M, Miller C, Brown B, Schmitt M (2014) Cardiac MRI of patients with implanted electrical cardiac devices. Heart. 100(5):363–369PubMedCrossRef
10.
Irnich W, Irnich B, Bartsch C, Stermann W, Gufler H, Weiler G (2005) Do we need pacemakers resistant to magnetic resonance imaging? Europace. 7(4):353–365PubMedCrossRef
11.
Roguin A, Zviman MM, Meininger GR et al (2004) Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: in vitro and in vivo assessment of safety and function at 1.5 T. Circulation. 110(5):475–482PubMedPubMedCentralCrossRef
12.
Indik JH, Gimbel JR, Abe H et al (2017) 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 14(7):e99–e151PubMedCrossRef
13.
Lowe MD, Plummer CJ, Manisty CH, Linker NJ (2015) Safe use of MRI in people with cardiac implantable electronic devices. Heart. 101(24):1950–1953PubMedCrossRef
14.
Brignole M, Angelo A, Baron-Esquivias G et al (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 34(29):2281–2329PubMedCrossRef
15.
Nazarian S, Hansford R, Rahsepar AA et al (2017) Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med 377(26):2555–2564PubMedPubMedCentralCrossRef
16.
Russo RJ, Costa HS, Silva PD et al (2017) Assessing the risks associated with MRI in patients with a pacemaker or defibrillator. N Engl J Med 376(8):755–764PubMedCrossRef
17.
Kabil J, Belguerras L, Trattnig S, Pasquier C, Felblinger J, Missoffe A (2016) A review of numerical simulation and analytical modeling for medical devices safety in MRI. Yearb Med Inform 33:152–158CrossRef
18.
Shah AD, Morris M, Hirsh D et al (2018) Magnetic resonance imaging safety in nonconditional pacemaker and defibrillator recipients: a meta-analysis and systematic review. Heart Rhythm 15(7):1001–1008PubMedCrossRef
19.
Wazni O, Epstein LM, Carrillo RG et al (2010) Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 55(6):579–586PubMedCrossRef
20.
Jones SO IV, Eckart RE, Albert CM, Epstein LM (2008) Large, single-center, single-operator experience with transvenous lead extraction: outcomes and changing indications. Heart Rhythm 5(4):520–525PubMedCrossRef
21.
Poole JE, Gleva MJ, Mela T et al (2010) Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation. 122(16):1553–1561PubMedCrossRef
22.
Cruypeninck Y, Dubourg B, Michelin P et al (2017) Pacemakers and MRI: a protocol in line with international guidelines and approved by the SFICV (French Society of Cardiovascular Imaging). Diagn Interv Imaging 98(3):203–215PubMedCrossRef
23.
Maglia G, Curnis A, Brieda M et al (2015) Assessing access to MRI of patients with magnetic resonance-conditional pacemaker and implantable cardioverter defibrillator systems. J Cardiovasc Med (Hagerstown) 16(10):715PubMedCrossRef
24.
25.
Nazarian S, Reynolds MR, Ryan MP, Wolff SD, Mollenkopf SA, Turakhia MP (2016) Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators. J Magn Reson Imaging 43(1):115–127PubMedCrossRef
26.
Sabzevari K, Oldman J, Herrey AS, Moon JC, Kydd AC, Manisty C (2017) Provision of magnetic resonance imaging for patients with “MR-conditional” cardiac implantable electronic devices: An unmet clinical need. Europace. 19(3):425–431PubMed
27.
28.
Celentano E, Caccavo V, Santamaria M et al (2017) Access to magnetic resonance imaging of patients with magnetic resonance-conditional pacemaker and implantable cardioverter defibrillator systems: results from the Really ProMRI study. Europace 20(6):1001–1009CrossRef
29.
Bhuva AN, Feuchter P, Hawkins A et al (2019) MRI for patients with cardiac implantable electronic devices-simplifying complexity with a ‘one-stop’ service model. BMJ Qual Saf 0:1–6
30.
Jung W, Zvereva V, Hajredini B, Jäckle S (2011) Initial experience with magnetic resonance imaging-safe pacemakers : a review. J Interv Card Electrophysiol 32(3):213–219PubMedPubMedCentralCrossRef
31.
Padmanabhan D, Kella DK, Mehta R et al (2017) Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads. Heart Rhythm 15(2):228–233PubMedCrossRef
32.
Shulman RM, Hunt B (2018) Cardiac implanted electronic devices and MRI safety in 2018—the state of play. Eur Radiol 28(10):4062–4065PubMedCrossRef
33.
Bhuva AN, Kellman P, Graham A et al (2019) Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices. Int J Cardiol 279:72–78PubMedCrossRef
34.
Rashid S, Rapacchi S, Vaseghi M et al (2014) Improved late gadolinium enhancement MR imaging for patients with implanted cardiac devices. Radiology. 270(1):269–274PubMedPubMedCentralCrossRef
35.
Hilbert S, Jahnke C, Loebe S et al (2017) Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality. Eur Heart J Cardiovasc Imaging 19(9):1051–1061CrossRef
36.
Nazarian S, Roguin A, Zviman MM et al (2006) Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable-cardioverter defibrillators at 1.5 tesla. Circulation. 114(12):1277–1284PubMedPubMedCentralCrossRef
37.
Samar H, Yamrozik JA, Williams RB et al (2017) Diagnostic value of MRI in patients with implanted pacemakers and implantable cardioverter-defibrillators across a cross population: does the benefit justify the risk? A proof of concept study. JACC Clin Electrophysiol 3(9):991–1002PubMedCrossRef
38.
39.
40.
41.
Deloitte Centre for Health Solutions (2013) Working differently to provide early diagnosis: improving access to diagnostics. Available via http://​www.​deloitte.​com. Accessed 22 June 2017
42.
Savouré A, Mechulan A, Burban M, Olivier A, Lazarus A (2015) The Kora pacemaker is safe and effective for magnetic resonance imaging. Clin Med Insights Cardiol 9:85–90PubMedPubMedCentralCrossRef
43.
44.
45.
Kmietowicz Z (2018) Patients with cardiac devices should not be excluded from MRI scans, say experts. BMJ. 362:k3623PubMedCrossRef
46.
47.
Metadata
Title
Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change
Authors
A. N. Bhuva
R. Moralee
J. C. Moon
C. H. Manisty
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06449-5

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