The Lead Episode 47: Multicenter retrospective evaluation of magnetic resonance imaging in pediatric and congenital heart disease patients with cardiac implantable electronic devices.-The Lead Episode 47 (Visual Aid)

The Lead Episode 47 (Visual Aid)

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This article summarizes a multicenter retrospective evaluation of the use of magnetic resonance imaging (MRI) in pediatric and congenital heart disease (CHD) patients with cardiac implantable electronic devices (CIEDs). The researchers aimed to assess the risk of adverse events during MRI scans in these patients. The study included patients with epicardial or abandoned leads, and the primary outcomes of interest were adverse patient events or significant changes in lead threshold, impedance, or sensing.<br /><br />The study involved 314 patients from 14 institutions, with 389 MRIs performed (82% in CHD patients). The majority of MRIs were performed in non-MRI-conditional CIEDs. The most common types of MRIs performed were cardiac (45%) and brain (33%). The results showed that symptoms, arrhythmias, or CIED changes occurred in 4.9% of scans (6.1% of patients). The most common complications reported were warmth, tingling and pain, pre-syncope, bradycardia, and premature termination of the scan due to artifact. Clinically significant CIED parameter changes were observed in 3.4% of patients.<br /><br />The authors consider this study to be the largest evaluation of MRI use in pediatric and adult congenital heart disease patients with CIEDs. They conclude that MRIs can be safely performed in these patients with rare, minor complications. However, the authors also discuss some limitations of the study, including data availability, variability in MRI protocols and patient selection, and selection bias.<br /><br />This study may have implications for the guidelines on MRI use in patients with CIEDs. The authors question whether the findings of this study should change the level of evidence for the current consensus recommendation on MRI use in these patients. They also highlight the need for further research on the definition of "significant change" in CIED parameters.<br /><br />Overall, this study provides valuable insights into the safety of MRI use in pediatric and congenital heart disease patients with CIEDs, suggesting that MRI scans can be performed with minimal risk of adverse events.

Keywords

magnetic resonance imaging

pediatric

congenital heart disease

cardiac implantable electronic devices

adverse events

epicardial leads

abandoned leads

lead threshold

lead impedance

lead sensing