Can a patient with retained pacemaker (Pacemaker) leads undergo a Magnetic Resonance Imaging (MRI) scan?

From the Guidelines

Patients with retained pacemaker leads should not undergo a Magnetic Resonance Imaging (MRI) scan due to the risk of lead heating, tissue damage, and cardiac arrhythmias, as stated in the 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy 1. When considering an MRI scan for a patient with a retained pacemaker lead, it is crucial to weigh the potential benefits against the risks. The primary concern is the interaction between the lead and the MRI's magnetic field, which can cause heating and potentially lead to serious complications.

Key Considerations

• The 2013 ESC guidelines recommend excluding patients with abandoned or epicardial leads from undergoing an MRI scan, as these leads are prone to heating 1.
• The guidelines also suggest that patients with leads implanted less than 6 weeks before the MRI scan should be excluded, as the leads may not have matured and are at risk of dislodgement 1.
• For patients who are not pacemaker-dependent, an inhibited pacing mode should be used to avoid inappropriate pacing due to electromagnetic interference, while pacemaker-dependent patients should be programmed to an asynchronous pacing mode to avoid inappropriate inhibition of pacing 1.

Alternative Imaging Options

• If diagnostic imaging is necessary for a patient with retained pacemaker leads, alternative methods such as CT scans, ultrasound, or X-rays may be safer options.
• It is essential to inform healthcare providers about any implanted devices or retained components before undergoing any imaging procedure.

Specialized Protocols

• In some cases, MRI might be possible under very specific conditions with specialized protocols, requiring evaluation by a cardiologist and radiologist working together, using an MRI machine capable of conditional scanning, with appropriate monitoring throughout the procedure 1.

From the Research

MRI Scans for Patients with Retained Pacemaker Leads

• Patients with retained pacemaker leads can undergo MRI scans, but with certain precautions and considerations 2, 3.
• The risk of MRI in patients with abandoned pacemaker leads is low, and the growing aggregate of data questions the absolute contraindication for MRI in these patients 3.
• Studies have shown that MRI scans can be performed safely in patients with pacemaker systems designed for safe use in MRI environments 4, 5.
• Pre- and post-MRI checks of the device are recommended, as well as extensive monitoring and the availability of necessary personnel to deal with an emergency 2.
• The benefit of MRI may far outweigh its risks if the indication has been established for the particular patient as an interdisciplinary decision and if the appropriate precautions are observed during scanning 2.

Safety Precautions and Considerations

• Patients with abandoned leads can undergo MRI scans with a low risk of complications, including no abnormal vital signs or sustained tachyarrhythmias 3.
• CIED parameter changes, including decreased right atrial sensing and decreased left ventricular R-wave amplitude, were transiently noted in some patients 3.
• One patient with an abandoned subcutaneous array experienced sternal heating that subsided on premature cessation of the study 3.
• MRI scans can be performed without positioning restrictions, limiting the powerful utility of MRI 5.

Device-Specific Considerations

• Newer pacemaker systems have been approved for MRI scanning under certain conditions 2.
• The Advisa MRI pulse generator and CapSureFix MRI 5086MRI lead system is safe and effective in the 1.5 T MRI environment without positioning restrictions for MRI scans or limitations of body parts scanned 5.
• Patients with non-pacemaker/defibrillator metallic devices and abandoned leads can undergo MRI scans with appropriate precautions and protocols 6.