MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR

Abstract

Purpose of review

How to implement a program for MRI in patients with conditional and non-conditional ("legacy") CIED. How to optimize safety and image quality in CMR? What the radiologists need to know: device programming, pre- and post-MRI CIED parameters.

Recent findings

New Center for Medicare and Medicaid Services (CMS) guidelines have opened MRI to many patients with nonconditional devices. Newer pulse sequences for cardiac MRI (CMR) in device patients, including modified cine, late gadolinium enhancement and T1 mapping sequences, have resulted in improved image quality in device patients. We present several cases of CMR in device patients, including imaging of leadless pacemakers subcutaneous ICDs. Imaging pitfalls/artifacts in CMR interpretation are also presented.

Summary

An organized institutional workflow with an established protocol involving proper patient screening, device programming, scan monitoring, and pre- and post-ICD interrogation minimizes risk in patients with conditional and non-conditional CIEDs. Although rare, significant changes in lead performance, power-on/reset, inappropriate pacing or ICD discharges and battery voltage depletion should be documented. High-quality scans with accurate scar characterization in CIED patients require the use of wideband sequences. CMS has recently acknowledged MRI as a reasonable test necessary for the diagnosis and treatment of beneficiaries with implanted CIEDs, improving the financial prospects and encouraging future developments.