Abstract 4367828: Pacemaker Magnetic Resonance Imaging: Building Equity for Patients with Cardiovascular Implantable Electronic Devices

Abstract

Background: More than 2 million people in the United States have cardiovascular implantable electronic devices (CIEDs), such as pacemakers or implantable cardioverter defibrillators. CIED patients often develop medical conditions that require magnetic resonance imaging (MRI) for diagnostic accuracy. Prior to 09/28/2021, MRI was not permitted for CIED patients at our safety-net hospital, stroke center, and trauma center. There are risks when unstable individuals must be transferred to other centers for imaging. Hypothesis: MRI-conditional CIED patients can be scanned without harm at our safety-net hospital based on a guideline-directed policy that includes experienced MRI staff, ACLS-trained nurses, general cardiologists, and manufacturer representatives. Goals: Pacemaker MRI available Monday to Friday, 8AM to 5PM. Included: Devices FDA-designated as safe under specific conditions (MRI-conditional). Excluded: Devices that are not MRI-conditional. No abandoned leads, epicardial leads, temporary transvenous systems. No device outside the thorax or at end of battery life. Approach: Graphic 1. Attending Radiologist confirms MRI is the most appropriate diagnostic modality available. Attending Cardiologist responds to questions about underlying condition(s) and device programming. Results: Graphic 2. No adverse outcomes after 68 scans for 41 patients with MRI-conditional devices. No deaths, tissue injuries, pauses, ventricular arrhythmias, or significant changes in programmed parameters. Median age: 77 years. Outpatients: 25. Inpatients: 16. Representative Scenarios: Stroke, Trauma, Infection, Malignancy. Conclusions: We developed a safe and sustainable MRI workflow at our safety-net hospital, stroke center, and trauma center. We are now engaging stakeholders from Critical Care, Nursing, Anesthesia, Cardiology, and other services to improve workflows for ICU patients with CIEDs. We will explore the feasibility of imaging individuals with MRI non-conditional devices.