Is a cardiology consult required to remove an external vest defibrillator (WCD) for a patient undergoing an MRI?

From the Guidelines

A cardiology consult is not required to remove an external vest defibrillator (WCD) for a patient undergoing an MRI. The WCD must be completely removed before the MRI as it contains metal components and electronic elements that are incompatible with the strong magnetic field of the MRI machine 1. The healthcare team performing the MRI can remove the device, but they should document the removal and ensure the device is properly reapplied after the imaging is complete. During the time the patient is without the WCD, appropriate monitoring should be maintained based on the patient's risk level, which may include continuous cardiac monitoring or having emergency equipment readily available. The patient should be informed about the temporary removal of this protective device.

Some key points to consider when removing the WCD include:

• Ensuring the patient's risk level is assessed and appropriate monitoring is maintained during the removal period
• Documenting the removal and reapplication of the device
• Informing the patient about the temporary removal of the device and the potential risks associated with it
• Considering communication with the patient's cardiologist regarding the temporary discontinuation of this therapy, especially for high-risk patients, to ensure proper risk assessment and management during the period without defibrillator protection.

It's also important to note that the WCD is typically used for patients with poor LV systolic function who are at risk of sudden arrhythmic death for a limited period, but are not candidates for an implantable defibrillator 1. However, the removal of the device for an MRI does not necessarily require a cardiology consult, but rather careful planning and monitoring to ensure the patient's safety during the procedure.

From the Research

Removal of External Vest Defibrillator for MRI

• The patient has an external vest defibrillator (WCD) that needs to be removed for an MRI scan, according to the MRI technician.
• The question is whether a cardiology consult is required to remove the WCD.

Relevant Studies

• A study published in 2017 2 discusses the wearable cardioverter defibrillator as a bridge or alternative to implantation, but does not specifically address the removal of the device for MRI scans.
• Another study from 2013 3 mentions the use of the WCD for risk stratification and temporary bridging, but also does not provide guidance on removal for MRI.
• A study from 2016 4 reports on the use of the WCD in an Australian center, including its use as a bridging therapy, but does not discuss removal for MRI scans.
• Studies from 2010 5 and 2017 6 focus on the safety of MRI scans in patients with cardiovascular implantable electronic devices, including pacemakers and ICDs, but do not specifically address the removal of external vest defibrillators.

Removal Procedure

• There is no direct evidence from the provided studies to suggest that a cardiology consult is required to remove an external vest defibrillator for an MRI scan.
• However, it is likely that the removal of the device should be done under medical supervision, given the potential risks associated with the device and the MRI scan.
• The decision to remove the device and the procedure for doing so should be made in consultation with the patient's healthcare team, including the cardiologist and the MRI technician.