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

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.

Download Full-text

165 Logistical demand of running a high-volume MRI service for patients with cardiac implantable electronic devices: findings from a ‘one-stop’ service model

10.1136/heartjnl-2021-bcs.162 ◽

2021 ◽

Author(s):

Benjamin Dowsing ◽

Anish Bhuva ◽

Lizette Cash ◽

Emily Webb ◽

James Moon ◽

...

Keyword(s):

Electronic Devices ◽

High Volume ◽

Service Model ◽

Cardiac Implantable Electronic Devices ◽

One Stop

Download Full-text

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

European Radiology ◽

10.1007/s00330-019-06449-5 ◽

2019 ◽

Vol 30 (3) ◽

pp. 1378-1384 ◽

Cited By ~ 5

Author(s):

A. N. Bhuva ◽

R. Moralee ◽

J. C. Moon ◽

C. H. Manisty

Keyword(s):

Treatment Planning ◽

Cancer Diagnosis ◽

Financial Incentives ◽

Electronic Devices ◽

Healthcare Providers ◽

Diagnosis And Treatment ◽

Cardiac Device ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Mri Scans

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.

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

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.

Download Full-text

Lymphoma presenting as neck lumps: causes of waiting time target breaches and potential solutions

The Journal of Laryngology & Otology ◽

10.1017/s0022215113002466 ◽

2013 ◽

Vol 127 (11) ◽

pp. 1111-1115 ◽

Cited By ~ 3

Author(s):

H Raja ◽

L Pabla ◽

H Wheatley ◽

M R B Farr

Keyword(s):

Waiting Time ◽

Waiting Times ◽

Diagnosis And Treatment ◽

Retrospective Survey ◽

Rapid Access ◽

One Stop ◽

Neck Lump ◽

Subsequent Target ◽

Radiological Examinations

AbstractObjectives:This study aimed to assess the speed of referral, diagnosis and treatment of patients with lymphoma presenting with a neck lump, and to identify where delays are occurring that prevent UK national targets from being met.Method:The study entailed a retrospective survey of patients presenting with a neck lump secondary to lymphoma between 2006 and 2008 in Gloucestershire, UK.Results:Forty-seven of 54 patients (87 per cent) were seen within 2 weeks of referral. However, the 62-day rule, which covers the time from referral to the initiation of treatment, was met in only 32 of the 54 cases (59 per cent). There were no breaches of the 31-day target, which concerned the time from decision to treat to the initiation of treatment. Subsequent target breaches were due to longer waiting times for radiological and pathological investigations.Conclusion:Radiological examinations should be ordered at the first consultation and biopsies performed as soon as possible. Establishing one-stop, rapid access clinics should improve the achievement of a maximum 62-day wait for patients with lymphoma presenting with neck lumps.

Download Full-text

Prospective Evaluation of a Novel One-Stop Testicular Clinic

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x301055 ◽

2008 ◽

Vol 90 (7) ◽

pp. 565-570 ◽

Cited By ~ 13

Author(s):

Mark Rochester ◽

Sue Scurrell ◽

John RW Parry

Keyword(s):

General Practitioner ◽

Waiting Time ◽

Waiting Times ◽

Intravenous Urography ◽

Testicular Tumour ◽

Nurse Specialist ◽

Imaging Department ◽

One Stop ◽

Several Delays ◽

Gp Care

INTRODUCTION In 2003, the waiting time for routine scrotal assessment approached 6 months in our hospital. The patients' diagnostic pathway was not uniform and involved several delays between general practitioner, radiologist and urologist. If malignancy was suspected, patients were seen and assessed within 2 weeks. However, it was possible for patients with unsuspected malignancy to have their diagnosis delayed. PATIENTS AND METHODS Funding was provided by the NHS Modernisation Agency's Action On Urology project. Men who were referred by their general practitioner (GP) with a testicular or scrotal condition would be reviewed in a one-stop joint sonographer and urology nurse specialist clinic provided entirely within the urology department with rapid open access. Data were prospectively collected for 2 years. Source of referral, suspected diagnosis, findings and outcome were recorded. RESULTS A total of 1017 patients attended the clinic over this period; of these, 203 (4%) were referred under the ‘2-week wait’ criteria. Of patients attending the clinic, 79% were discharged to GP care, 8% were added to the waiting list for a surgical procedure and 20% were referred with ‘testicular lump’. Eleven patients were suspected to have testicular tumour on ultrasound and proceeded to orchidectomy in this period. One patient (0.1%) was found to have an unsuspected seminoma. The waiting time for all scrotal ultrasound examinations has fallen from 22 to 2 weeks. The waiting times for intravenous urography and general ultrasound were also significantly reduced following the introduction of this service (P = 0.005). CONCLUSIONS The majority of patients passing through this clinic are the ‘worried-well’ with benign scrotal pathology. They can now be seen within 2 weeks regardless of whether their GP suspects testicular tumour. This reduces anxiety in this large group of patients freeing capacity elsewhere in the diagnostic imaging department.

Download Full-text

Remote Programming of Cardiac Implantable Electronic Devices: A Novel Approach to Program Cardiac Devices for Magnetic Resonance Imaging

10.22541/au.163689587.73457767/v1 ◽

2021 ◽

Author(s):

Sisir Siddamsetti ◽

Alexander Shinn ◽

Sandeep Gautam

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Electronic Devices ◽

Remote Access ◽

Resonance Imaging ◽

Mri Scan ◽

Cardiac Implantable Electronic Devices ◽

Cardiac Devices ◽

Access Code ◽

Mri Scans

Background Magnetic Resonance imaging (MRI) in patients (pts) with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIED’s in pts undergoing MRI scan. Methods We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from 2090 Medtronic programmer over CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 pts who underwent RP of CIED’s for MRI. Outcomes analyzed were safety parameters during RP. Results Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any pt. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Conclusions Remote programming of CIED’s for MRI scans is a safe and effective strategy.

Download Full-text