Multicenter retrospective evaluation of magnetic resonance imaging in pediatric and congenital heart disease patients with cardiac implantable electronic devices

Lindsey Gakenheimer-Smith, Zhining Ou, Jinqiu Kuang, Jeremy P. Moore, Austin Burrows, Joshua Kovach, Brynn Dechert, Cheyenne M. Beach, Mark Ayers, Reina Bianca Tan, Mina Mostafavifar, Douglas Y. Mah, Tracy Marrs Conner, Susan Turpin, Kishor Avasarala, Maully J. Shah, Gregory Webster, Jessica Posey, Susan P. Etheridge, Edem BinkaMary Niu, S. Yukiko Asaki, Linda M. Lambert, Thomas A. Pilcher

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Guidelines addressing magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) provide algorithms for imaging pediatric and congenital heart disease (CHD) patients. Guideline acceptance varies by institution. Guidelines also do not support routine MRI scans in patients with epicardial or abandoned leads, common in pediatric and CHD patients. Objective: The purpose of this study was to determine the incidence of MRI-related complications in pediatric and CHD patients with CIEDs, including epicardial and/or abandoned leads. Methods: A multicenter retrospective review included patients with CIEDs who underwent any MRI between 2007 and 2022 at congenital cardiac centers. The primary outcome was any patient adverse event or clinically significant CIED change after MRI, defined as pacing lead capture threshold increase >0.5 V with output change, P- or R- wave amplitude decrease >50% with sensitivity change, or impedance change >50%. Results: Across 14 institutions, 314 patients (median age 18.8 [1.3; 31.4] years) underwent 389 MRIs. There were 288 pacemakers (74%) and 87 implantable cardioverter-defibrillators (22%); 52% contained epicardial leads, and 14 (4%) were abandoned leads only. Symptoms or CIED changes occurred in 4.9% of MRI scans (6.1% of patients). On 9 occasions (2%), warmth or pain occurred. Pacing capture threshold or lead impedance changes occurred in 1.4% and 2.0% of CIEDs post-MRI and at follow-up. Conclusion: Our data provide evidence that MRIs can be performed in pediatric and CHD patients with CIEDs, including non–MRI-conditional CIEDs and epicardial and/or abandoned leads, with rare minor symptoms or CIED changes but no other complications.

Original languageEnglish
Pages (from-to)1752-1758
Number of pages7
JournalHeart rhythm
Volume20
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • Abandoned lead
  • Cardiac implantable electronic device
  • Congenital heart disease
  • Epicardial lead
  • Magnetic resonance imaging
  • Pediatrics

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