Abstract 12412: Imaging the PM/AICD Patient; Does the Diagnostic Value Justify the Risk?

Background: MR imaging is infrequently performed on patients with implanted pacemakers/AICDs. When the risk justifies the end, however, consideration to perform 'high-risk’ scanning can be made on a case-by-case basis but typically with trepidation. This raises a critically important question: "Is the MRI scan adding valuable and irrefutable information to warrant such risk? Methods: 84 patients with implanted devices (13AICD,10 AICD/PM,5 retained leads, 6 REVO and 50 dual chamber PM.) were imaged via MRI/CMR (1.5T GE, Milwaukee, WI) over 3 years in a single institution. Specific criteria were followed for all patients to objectively define whether final diagnosis by MRI imaging enhanced patient care. A checklist of 3 questions was answered following scan interpretation by both the technologist and performing MRI physician(s): 1) Did the diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ‘Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or therapy. Results: All patients completed the procedure with no death, VT/VF, power-on-reset or adverse events. Average MRI study time: 20±55min. The device was interrogated pre and post MRI by EP/cardiologist to determine changes in impedance, amplitude or threshold. No clinically meaningful changes occurred, no post-procedure revisions to generator/lead or parameters were required. Conclusion: The use of PM/AICD imaging in MRI remains controversial. Our study shows that MR imaging in carefully selected patients under the supervision of experienced physicians is not only safe but extremely beneficial, substantially adding value and often irrefutable information to patient diagnosis and management. PM/AICDs when imaged properly are safe and no longer 'forbidden’ in the MRI environment. Moreover there is frequently marked life-altering and life-saving information obtained.