title: A protocol for patients with cardiovascular implantable devices undergoing magnetic resonance imaging (MRI): should defibrillation threshold testing be performed post-(MRI).
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) in patients with Cardiovascular Implantable Electronic Devices (CIED) has not been approved by the Food and Drug Administration. Recent data suggests MRI as a relative rather than absolute contraindication in CIED patients. Recently, the American Heart Association has recommended defibrillation threshold testing (DFTT) in implantable cardioverter defibrillator (ICD) patients undergoing MRI. We evaluated the feasibility and safety of a protocol for MRI in CIED patients, incorporating the new recommendations on DFTT.
  
  
  METHODS
  Consecutive patients with CIED undergoing MRI were included. The protocol consisted of continuous monitoring during imaging, device interrogation pre- and post-MRI, reprogramming of the pacemaker to an asynchronous mode in pacemaker-dependent (PMD) patients and a non-tracking/sensing mode for non-PMD patients. All tachyarrhythmia therapies were disabled. Devices were interrogated for lead impedance, battery life, pacing, and sensing thresholds. All patients with ICD underwent DFTT/defibrillator safety margin testing (DSMT) post-MRI.
  
  
  RESULTS
  A total of 92 MRI's at 1.5 Tesla were performed in 38 patients. A total of 13 PMD patients, ten ICD patients, four cardiac resynchronization therapy with defibrillator (CRT-D) patients, and 11 non-PMD patients were scanned from four major manufacturers. No device circuitry damage, programming alterations, inappropriate shocks, failure to pace, or changes in sensing, pacing, or defibrillator thresholds were found on single or multiple MRI sessions.
  
  
  CONCLUSIONS
  Our protocol for MRI in CIED patients appears safe, feasible, and reproducible. This is irrespective of the type of CIED, pacemaker dependancy or multiple 24-h scanning sessions. Our protocol addresses early detection of potential complications and establishes a response system for potential device-related complications. Our observation suggests that routine DFTT/DSMT post-MRI may not be necessary.
authors.affiliation: Providence Heart Institute, Providence Hospital, 16001 W. Nine Mile Rd., Southfield, MI 48075, USA.
authors.forename: Peter Thomas
authors.initials: PT
authors.lastname: Burke
authors.forename: Hamid
authors.initials: H
authors.lastname: Ghanbari
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Alexander
authors.forename: Michael K
authors.initials: MK
authors.lastname: Shaw
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Christian
authors.initials: C
authors.lastname: Machado
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D000075202:Contraindications; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects*; D008297:Male; D010138:Pacemaker, Artificial; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011336:Probability; D018570:Risk Assessment; D012308:Risk Management; D018709:Statistics, Nonparametric; D014481:United States; D014486:United States Food and Drug Administration