Abstract 4366149: A REPORT OF >2000 CONSECUTIVE NON-SELECTED PATIENTS UNDERGOING IMAGING WITH PACEMAKER'S AND ICD'S IN THE MRI ENVIRONMENT; THE ADDITIVE VALUE OF A LARGE, PROSPECTIVE >20-YEAR OBSERVATIONAL STUDY

Abstract

Background: While imaging of conventional PM’s and ICDs is infrequently performed via MRI, many studies, including the MagnaSafe have unequivocally supported MRI safety in such pts. However, the added clinical value is infrequently considered. Accordingly, we performed a prospective study to determine the 'Additive Value' beyond safety for pts with conventional PM/ICD's undergoing MRI. We hypothesized that MRI in PM/ICD pts is fundamental to an existing diagnosis, often markedly altering patient diagnosis and downstream care. Methods: An MRI Device exam (GE 1.5T,WI) pioneered by cardiologists (>90% over 10 yrs; 100% over 21 years) was performed. A series of prospective questions using Boolean Logic Construct were answered within 1 week of MRI by both MRI tech's and MRI MD's. Questions: 1) Did primary diagnosis change? 2) Did MRI provide additional information to existing diagnosis? 3) Was pre-MRI (tentative) diagnosis confirmed? 4) Did subsequent pt management change? If 'Yes' was answered to any questions, MRI was considered of value to pt diagnosis and/or impending therapy Results: Avg MRI: 23±15min for 2,128 consecutive pts of which 1,1617 (76%) were neuro/neurosurgery, 149 (7%) were musculoskeletal and 362 (17%) were CV cases. Upon review: of Neuro MRIs, 1,439 (89%) provided additional information. The diagnosis changed in 1213 (75%) while therapy changed in 1148 (71%). In only 129 (8%) did MRI simply confirm original diagnosis. Cardiac MRI changed original the diagnosis in 253 (70%). MRI did not contribute in 43 (12%) due to uninterpretable (ICD artifact), while in 66 pts, the diagnosis did not change. Finally, in 355, Orthopedic MRI provided additional information in 143 (98%) and in 326 (90%), changed pt care, and in 14 (3%), simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any patient all with tracking for >1 year. Conclusion: A dedicated Universal Program of MRI in PM/ICD patients adds remarkable clinical value to diagnosis and subsequent management justifying any residual risk(s). Accordingly, we propose that yet another hurdle to the advancement of CMR-PM/ICD strategies can become standard and often life-changing.