Multidisciplinary MRI protocol in patients with CIEDs and ILRs: a five-year single-centre experience

Background Magnetic resonance imaging (MRI) in patients with cardiovascular implantable electronic devices (CIEDs) is often restricted due to safety concerns, particularly in the presence of hybrid generator–lead systems or non–MR-conditional devices. Despite growing evidence of feasibility, standardised protocols are not consistently implemented in clinical practice. Methods We report a five-year experience (2019–2024) from a tertiary referral centre that adopted a structured, multidisciplinary protocol for MRI in patients with CIEDs and implantable loop recorders (ILRs). A coordinated team of radiologists, cardiologists, and MRI physicists performed systematic pre-scan assessment, verification of device conditionality, and individualized planning. On-site cardiology supervision ensured programming to MRI mode, continuous monitoring, and post-scan device interrogation with restoration of baseline settings. Results A total of 510 patients with CIEDs or ILRs were evaluated; 447 (88%) successfully underwent MRI at 1.5 Tesla. MRI was contraindicated in 12% of ICD carriers and 16% of pacemaker patients, primarily due to MR-unsafe pulse generators (75%) or non-approved generator–lead combinations (18%). No device malfunctions, lead failures, significant changes in pacing thresholds, arrhythmias, or clinical adverse events occurred following MRI. All ILR patients were scanned uneventfully, with no memory loss or signal artefacts. Hybrid CIED configurations, despite individually MR-conditional components, represented the most frequent cause of exclusion. Conclusion MRI can be safely performed in the majority of patients with CIEDs and ILRs when managed through a multidisciplinary protocol integrating device expertise and radiological safety. The main barrier to universal access remains device heterogeneity and lack of manufacturer labelling for hybrid systems. Broader implementation of harmonised protocols and collaboration between cardiology and radiology teams are essential to ensure equitable MRI access for this expanding patient population.Figure 1Table 1