1349186 - The Additive Value Of Pacemakers And ICDs In The Mri Environment Over 19 Years; A Large, Prospective, Longitudinal, Observational Study

Background: MRI is infrequently performed on pts with conventional PM’s and ICDs. While many studies, including MagnaSafe, have unequivocally supported MRI safety in pts with such devices, the clinical value has rarely been considered. Accordingly, we performed an observational, prospective study to determine the relative 'Additive Value' that occurs beyond safety for pts with conventional PM/ICD undergoing clinical MRI.

Hypothesis:  We propose that MRI in PM/ICD pts is crucial to an existing diagnosis and often, substantially alters diagnosis and subsequent management.

Methods: An MRI Device exam (GE 1.5T,WI) pioneered by cardiologists ( >95% over 19 yrs) was performed. Subsequently, a series of defining questions using Boolean Logic Construct were answered within 1 week of MRI by both MRI technologist and MRI physicians: 1) Did the primary diagnosis change? 2) Did MRI provide additional information to existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If 'Yes' was answered to any of the above questions, it was considered that MRI was of value to patient diagnosis and/or impending therapy.

Results: Avg MRI: 25±13min for 1787 consecutive pts of which 1316 (74%) were neuro/neurosurgery, 145 (8%) were musculoskeletal and 327 (18%) were CV cases. Upon review: of the neuro/neurosurgery MRIs, 1158 (89%) provided additional information. The diagnosis changed in 857 (74%), while medical therapy changed in 822 (71%). In only 138 (11%) did MRI simply confirm original diagnosis. For cardiac pts, MRI changed the original diagnosis in 218 (67%). MRI did not contribute in 46 (14%) as it was uninterpretable (ICD artifact) while in 62 pts the diagnosis did not change. Finally, in musculoskeletal pts, MRI provided additional information in 139 (96%) and in 128 (88%), changed pt care and in 3 pts (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.

Conclusion: A dedicated program of utilizing MRI in PM/ICD patients adds substantial clinical value to both diagnosis and subsequent management justifying any inherent risk. We believe yet another impediment to the advancement of CMR-PM/ICD strategies has and should become routine leading to often life-changing clinical benefits.