Key result
Skipping CRT-D MRI mode during MRI causes temporary RV loss of capture and interference oversensing.
Why the study?
MRI in patients with implantable cardiac devices requires strict protocols and close cardiology-radiology collaboration to ensure safety and prevent device malfunction.
Case Report (n=1)
No
Failure to reprogram MR conditional cardiac devices into MRI mode prior to scanning can lead to temporary device malfunction, including loss of capture and oversensing, highlighting the need for strict multidisciplinary protocols.
Answers are grounded in this paper and cite their sources.
Emphasizes strict MRI protocol adherence for MR-conditional CRT-Ds; single case leaves open true incidence and predictors.
BACKGROUND: Magnetic resonance (MR) imaging (MRI) for patients with implantable cardiac devices is becoming more routine, with the development of MR conditional devices allowing more patients access to the imaging they need. However, for this to be performed safely, strict protocols must be followed necessitating close collaboration between cardiology and radiology departments. We present a case where mandatory device re-programming of a cardiac resynchronization therapy defibrillator device into MRI mode was not performed pre-scan leading to temporary device dysfunction with no clinical consequences. CASE SUMMARY: A 72-year-old man presented to a device clinic for a routine device interrogation. An atrial tachycardia response episode was recorded at the same time as the patient reported having undergone an MRI scan at a local centre. The electrogram demonstrated temporary right ventricular loss of capture with standard output programming, and a short episode of oversensing on the atrial and ventricular channel which was not sustained for long enough to meet tachycardia detection. DISCUSSION: We demonstrate two potential electrophysiological effects of MRI on pacemakers, where the device had not been appropriately re-programmed pre-procedure. This illustrates that whilst MRI in patients with implantable cardiac devices is safe, strict protocols must be followed requiring robust multidisciplinary communication.
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Monkhouse et al. (2021) conducted a case report in Implantable cardiac device (CRT-D) undergoing MRI (n=1). MRI without device re-programming was evaluated on Device function/malfunction. Undergoing an MRI without re-programming an MR conditional CRT-D into MRI mode led to temporary right ventricular loss of capture and oversensing of electromechanical interference.
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