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

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.

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MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009079 ◽

2019 ◽

Vol 28 (10) ◽

pp. 853-858 ◽

Cited By ~ 4

Author(s):

Anish N Bhuva ◽

Patricia Feuchter ◽

Angela Hawkins ◽

Lizette Cash ◽

Redha Boubertakh ◽

...

Keyword(s):

Waiting Time ◽

Waiting Times ◽

Electronic Devices ◽

National Standard ◽

Service Model ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Service Redesign ◽

Mri Scans ◽

One Stop

BackgroundPatients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.AimTo deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).MethodsPatients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.Results215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.ConclusionImplementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.

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Recent Advances in Pacing and Defibrillation

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:74 ◽

2011 ◽

Vol 3 (1) ◽

pp. 74

Author(s):

Kathy L Lee ◽

Keyword(s):

Cardiac Death ◽

Electronic Devices ◽

Implantable Defibrillators ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Treatment And Prevention ◽

Recent Advances ◽

Pacing Lead ◽

Leadless Pacing ◽

Device Complications

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

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The role of imaging tests in electrotherapy

In a good rythm ◽

10.5604/01.3001.0014.1504 ◽

2020 ◽

Vol 1 (54) ◽

pp. 23-29

Author(s):

Łukasz Mazurek ◽

Agnieszka Kotalczyk ◽

Michał Mazurek ◽

Ewa Jędrzejczyk-Patej

Keyword(s):

Sensitivity And Specificity ◽

Therapeutic Process ◽

Electronic Devices ◽

Diagnosis And Treatment ◽

Imaging Methods ◽

Cardiac Implantable Electronic Devices ◽

Wide Range

We currently have a wide range of different imaging tests that are constantly improving and developing. Each test has its sensitivity and specificity and is used in various fields of medicine. Knowledge of the possibilities of using imaging tests in electrotherapy is an important element of the diagnostic and therapeutic process. This article presents selected issues regarding the use of imaging methods in the diagnosis and treatment of patients with cardiac implantable electronic devices.

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CLINICAL OUTCOMES AFTER CARDIAC MRI SCANS OF NON-MRI-SAFE CARDIAC IMPLANTABLE ELECTRONIC DEVICES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30705-7 ◽

2016 ◽

Vol 67 (13) ◽

pp. 704

Author(s):

Justin Halbe ◽

Judith Fox ◽

James Oujiri ◽

James Roth ◽

Marcie Berger ◽

...

Keyword(s):

Clinical Outcomes ◽

Cardiac Mri ◽

Electronic Devices ◽

Cardiac Implantable Electronic Devices ◽

Mri Scans

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Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000111 ◽

2015 ◽

Vol 26 (4) ◽

pp. 356-363

Author(s):

Melanie T. Gura

Keyword(s):

Terminal Illness ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Life Saving ◽

Cardioverter Defibrillators ◽

Proactive Communication

Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations.

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Late Breaking Clinical Trials: what do they change in everyday practice in patients who are or will be implanted with cardiac electrotherapy device?

In a good rythm ◽

10.5604/01.3001.0014.0496 ◽

2020 ◽

Vol 4 (53) ◽

pp. 4-7

Author(s):

Ewa Jędrzejczyk-Patej ◽

Michał Mazurek

Keyword(s):

Clinical Trials ◽

Electronic Devices ◽

Everyday Practice ◽

Cardiac Resynchronization ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Cardioverter Defibrillators

Patients with cardiac implantable electronic devices (CIEDs) constitute a considerable population. Issues related to CIEDs both in the field of cardiac pacemakers, cardioverter-defibrillators, and cardiac resynchronization are still intensively studied. This article presents the results of selected, relevant studies on CIEDs announced or published in 2019.

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Effectiveness And Adherence To Hospital Infection Control Preventive Practice In Cardiac Implantable Electronic Devices

QJM ◽

10.1093/qjmed/hcab090.017 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Michel Lotfy Kolta ◽

Maha Mohamed Mohamed Khalifa ◽

Mazen Tawfik Ibrahmi ◽

Said AbdElHaffez khaled

Keyword(s):

Diabetes Mellitus ◽

Infection Control ◽

Electronic Devices ◽

P Value ◽

Related Factors ◽

Cardiac Device ◽

Control Protocol ◽

The Past ◽

Cardiac Implantable Electronic Devices ◽

Device Implantation

Abstract Background Cardiac implantable electronic device (CIED) have been increasingly used in the past years, There is arise in CIED related complications in the past years with the increase in the number of devices implanted, CIED associated infection is challenging in its management, including system removal (generator and leads ), antimicrobial therapy, replantation at another site. Objectives The aim of the study is to evaluate the adherence to the steps of infection control protocol in cardiac device implantation related infection . Patients and Methods One hundred patients referred for cardiac device implantation was enrolled in the study and prospectively evaluated regarding applying of infection control measures and followed up for six months to study effect of adherence to these measures in prevention of postoperative device related infection. Results analysis of all factors of infection control protocol revealed significant correlation between postoperative device related infection and the following factors, Age ( p value = 0.010) , DM ( p value = 0.024) and number of Operators≥4.0 ( p = 0.001) as well as duration of sterilization ( p = 0.001), wearing double gloves (p = <0.001). Conclusion Our results proved certain factors as significant risk factors for device related infection, they are either patient related factors including and diabetes mellitus or device related factors reflecting higher incidence with CRT devices (p = 0.025), others related to applying anti septic measures namely double glove technique and duration of skin disinfect prior to the procedure. Abbreviation list; CIED (cardiac implantable electronic devices), DRI (device related infection), CKD (chronic kidney disease), DM (diabetes mellitus), HTN (hypertension), CRT (cardiac resynchronization therapy), DDD (dual chamber device), VVI (ventricular demand pacing), ICD (implantable cardioverter defibrillator).

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The experience of patients with cancer during diagnosis and treatment planning: a descriptive study of Canadian survey results

Current Oncology ◽

10.3747/co.24.3782 ◽

2017 ◽

Vol 24 (5) ◽

pp. 332 ◽

Cited By ~ 4

Author(s):

A.C. Coronado ◽

K. Tran ◽

J. Chadder ◽

J. Niu ◽

S. Fung ◽

...

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Treatment Planning ◽

Health Care Providers ◽

Cancer Diagnosis ◽

Care Provider ◽

Care Quality ◽

Diagnosis And Treatment ◽

Care Providers ◽

Ambulatory Oncology

Background Communication with health care providers during diagnosis and treatment planning is of special importance because it can influence a patient’s emotional state, attitude, and decisions about their care. Qualitative evidence suggests that some patients experience poor communication with health care providers and have negative experiences when receiving their cancer diagnosis. Here, we use survey data from 8 provinces to present findings about the experiences of Canadian patients, specifically with respect to patient–provider communication, during the diagnosis and treatment planning phases of their cancer care.Methods Data from the Ambulatory Oncology Patient Satisfaction Survey, representing 17,809 survey respondents, were obtained for the study.Results Most respondents (92%) felt that their care provider told them of their cancer diagnosis in a sensitive manner. Most respondents (95%) also felt that they were provided with enough information about their planned cancer treatment. In contrast, more than half the respondents who had emotional concerns upon diagnosis (56%) were not referred to services that could help with their anxieties and fears. Also, 18% of respondents reported that they were not given the opportunity to discuss treatment options with a care provider, and 17% reported that their care providers did not consider their travel concerns while planning for treatment.Conclusions Measuring the patient experience allows for an understanding of how well the cancer control system is addressing the physical, emotional, and practical needs of patients during diagnosis and treatment planning. Although results suggest high levels of patient satisfaction with some aspects of care, quality improvement efforts are still needed to provide person-centred care.

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