Safety of Cardiac and Non-Cardiac MRI in Patients with MRI Non-Conditional Cardiac Electronic Devices: A Systematic Review and Meta-Analysis

Akhtar, Tauseef

Safety of Cardiac and Non-Cardiac MRI in Patients with MRI Non-Conditional Cardiac Electronic Devices: A Systematic Review and Meta-Analysis

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Tauseef Akhtar, MD , John H Stroger Jr Hospital of Cook County, Chicago, IL

Muhammad Shahzeb Khan, MD , John H Stroger Hospital of Cook County, Chicago, IL

Muhammad Mustafa Memon, MD , Dow University of Health Sciences, Karachi, Pakistan

Nisar Asmi, MD , John H Stroger Jr Hospital of Cook County, Chicago, IL

Vincent Figueredo, MD , Einstein Medical Center, philadelphia, PA

Farouk Mookadam, MD , Mayo Clinic, Pheonix, AZ

Richard Krasuski, MD , Duke University Medical Center, Durham, NC

Rami Doukky, MD , John H Stroger Jr Hospital of Cook County, Chicago, IL

Background
Presence of cardiac implantable electronic devices (CIED) is traditionally considered a contraindication to magnetic resonance imaging (MRI). Although studies have demonstrated MRI safety in the presence of conditional CIED, safety data in patients with non-conditional devices remain scarce.

Methods
We conducted a systematic review of the literature using Medline, Scopus, Embase and the Cochrane library. Studies reporting cardiac and non-cardiac MRI safety outcomes based on pre and post-procedural evaluation of CIED in patients with non-compatible devices were included. Lead failure, death, arrhythmias, change in battery impedance and voltage, power reset, implantable cardioverter-defibrillator (ICD) shock, anti-tachycardia pacing (ATP) and patient-reported symptoms were the included outcomes. Proportions of categorical variables were pooled using a random-effects model after arcsine transformation.

Results
Our analysis included 29 studies containing 5647 patients with 6209 CIEDs (4264 pacemakers and 1945 ICDs) undergoing 6562 MRI examinations. Mortality rate was 1.5% (0.0%-6.8%). Incidence of arrythmia 0.7% (0.2%-1.4%), device failure 0.2% (0.0%-0.4%), lead failure 0.1% (0.0%-0.3%), power reset 1.9% (0.8%-3.5%), ICD shock 1.5% (0.6%-2.8%), ATP 1.5% (0.5%-3.1%), and patient reported symptoms 1.0% (0.0%-0.3%) were generally low. Changes in battery impedance 5.5% (0.2%-24.6%) and voltage 26.7% (3.1%-62.1%) occurred most frequently.

Conclusions
MRI examination in patients with non-compatible CIED is a relatively safe procedure. Substantial changes in battery impedance and voltage may warrant cautious use.