Key result
MRI yields 0 MACE or severe device dysfunctions in patients with abandoned or epicardial leads.
Why the study?
Despite reluctance to perform MRI due to in vitro reports of tip heating, there is a clear lack of safety data for MRI in patients with abandoned and/or epicardial leads.
Does magnetic resonance imaging cause major adverse cardiac events or device dysfunction in patients with abandoned and/or epicardial leads?
Meta-Analysis (n=656)
Does magnetic resonance imaging cause major adverse cardiac events or device dysfunction in patients with abandoned and/or epicardial leads?
MRI appears safe in patients with abandoned or epicardial leads when performed according to strict safety guidelines, though transient lead parameter changes and subjective sensations may occur.
Supports MRI in patients with abandoned/epicardial leads under guidelines; extends observational safety data but leaves prospective confirmation open.
AIMS: Persistent reluctance to perform magnetic resonance imaging (MRI) in patients with abandoned and/or epicardial leads of cardiac implantable electronic devices is related to in vitro studies reporting tip heating. While there is a plethora of data on the safety of MRI in conditional and non-conditional implantable devices, there is a clear lack of safety data in patients with abandoned and/or epicardial leads. METHODS AND RESULTS: Relevant literature was identified in Medline and CINAHL using the key terms 'magnetic resonance imaging' AND 'abandoned leads' OR 'epicardial leads'. Secondary literature and cross-references were supplemented. For reporting guidance, the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 was used. International Prospective Register of Systematic Reviews (PROSPERO) registration number 465530. Twenty-one publications with a total of 656 patients with 854 abandoned and/or epicardial leads and 929 MRI scans of different anatomical regions were included. No scan-related major adverse cardiac event was documented, although the possibility of under-reporting of critical events in the literature should be considered. Furthermore, no severe device dysfunction or severe arrhythmia was reported. Mainly transient lead parameter changes were observed in 2.8% in the subgroup of patients with functional epicardial leads. As a possible correlate of myocardial affection, subjective sensations occurred mainly in the subgroup with abandoned epicardial leads (4.0%), but no change in myocardial biomarkers was observed. CONCLUSION: Existing publications did not report any relevant adverse events for MRI in patients with abandoned and/or epicardial leads if performed according to strict safety guidelines. However, a more rigorous risk-benefit calculation should be made for patients with epicardial leads.
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Meier et al. (2024) conducted a meta-analysis in Cardiac implantable electronic devices with abandoned or epicardial leads (n=656). Magnetic resonance imaging (MRI) was evaluated on Scan-related major adverse cardiac events. Magnetic resonance imaging in 656 patients with abandoned or epicardial leads resulted in 0 scan-related major adverse cardiac events or severe device dysfunctions across 929 scans.
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