Magnetic resonance imaging in patients with cardiac implanted electronic devices in the UK: a large district hospital 5-year experience

Our centre provides secondary and tertiary care for a population of 544,000, with a dedicated program for performing magnetic resonance imaging (MRI) in patients with cardiac implanted electronic devices (CIED). Standard operating procedures for both conditional and non-conditional devices have been in place since 2019. Despite published evidence of safety, many concerns remain about scanning patients with CIEDs.

To review a large district hospital experience of performing MRI scans in device patients since 2019 and report on complications.

A prospective database was kept for MRI scans in CIED patients between May 2019 and September 2024. Retrospective data collection from electronic records was used to complete the dataset to include device type, MRI conditional status and device-related complications.

869 MRI requests were received during the study period. The mean age was 75 (24 - 99). Of the requests received, 559 (64%) were scanned, with 18 requests still pending at the time of analysis. Device types included: single or dual chamber pacemaker (402), single or dual chamber ICD (56), CRT-P (63), CRT-D (35), leadless pacemaker (1) and subcutaneous ICD (2). Of the devices scanned, 532 (95.2%) were declared to be MRI conditional (MRIc) and 27 (4.8%) were MRI non-conditional (MRINc). Asymptomatic intrinsic rhythm abnormalities were observed in 7 cases and in 3 of these the scan was discontinued for safety reasons. 3 cases required programming adjustments due to asymptomatic increased thresholds or reduced sensing immediately following the MRI, but none required lead repositioning or replacement or suffered physical harm. 1 scan was aborted on the day and the case referred to another centre due to an unspecified pre-scan device issue. There were 2 cases of pain reported over the device site in the MRI room, leading to scan termination. No major device-related complications were reported in either the MRIc or MRINc cohorts.

MRI scanning of CIEDs was safe with no major complications identified, including in a small subset of patients who were scanned with "non-conditional" device systems.