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Practice Guideline
. 2024 Summer;26(1):100995.
doi: 10.1016/j.jocmr.2024.100995. Epub 2024 Jan 12.

SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

Daniel Kim  1 , Jeremy D Collins  2 , James A White  3 , Kate Hanneman  4 , Daniel C Lee  5 , Amit R Patel  6 , Peng Hu  7 , Harold Litt  8 , Jonathan W Weinsaft  9 , Rachel Davids  10 , Kanae Mukai  11 , Ming-Yen Ng  12 , Julian A Luetkens  13 , Ariel Roguin  14 , Carlos E Rochitte  15 , Pamela K Woodard  16 , Charlotte Manisty  17 , Karolina M Zareba  18 , Lluis Mont  19 , Frank Bogun  20 , Daniel B Ennis  21 , Saman Nazarian  22 , Gregory Webster  23 , Jadranka Stojanovska  24
Affiliations
Practice Guideline

SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

Daniel Kim et al. J Cardiovasc Magn Reson. 2024 Summer.

Abstract

Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.

Keywords: Cardiac implantable electronic device; Cardiovascular magnetic resonance; Guidelines; MR safety.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Recommendations for planning and performing MRI scans in patients with CIEDs. *Higher risk scenarios include the presence of epicardial, abandoned leads, fractured; recent implantation; battery at elective replacement indicator/ requires replacement; deactivated systems; lead parameters outside manufacturer recommendations and other implants present. Appropriate person obtaining and confirming consent should be performed as per local protocol. ACLS: adult cardiac life support; BLS: basic life support; CIED: cardiac implantable electronic device; ERI: elective replacement indicator; SAR: specific absorption rate.
Fig. 2
Fig. 2
(Top row) Conventional T1 mapping, perfusion, and LGE of a patient with an S-ICD (see right panel) shows image artifacts, whereas (bottom row) the corresponding wideband pulse sequences suppressed image artifacts. S-ICD: subcutaneous ICD.
Fig. 3
Fig. 3
Exemplary CMR images in a patient with a left-sided CIED including short-axis GRE post-contrast images at end-diastole (A) and end-systole (B); 4-chamber GRE images pre-contrast (C) and post-contrast (D); and 2D phase contrast imaging at the ascending aorta (E, magnitude; and F, phase).
Fig. 4
Fig. 4
Chest radiographs from patients with congenital heart disease demonstrating a variety of non-MR-conditional CIED systems. (A) A dual chamber epicardial system placed in infancy. (B) A right-sided transvenous system placed in a patient with dextrocardia and a retained epicardial system. (C) A complex hybrid system after many years of CIED management, including bilateral transvenous systems, abandoned leads, an epicardial system tunneled to a subclavian pocket and an epicardial coil. Patients shown in (B) and (C) have an intravascular stent, unrelated to the pacing system.
Fig. 5
Fig. 5
Spectrum of risk for MRI in pediatric and congenital heart disease patients with a CIED.
See this image and copyright information in PMC

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