Magnetic Resonance Imaging and Radiation Exposure in Patients with Cardiovascular Implantable Electronic Devices

MR conditional devices should be considered MR conditional only when the product labeling is adhered to, which includes programming the appropriate "MR mode" and scanning with the prerequisites specified for the device. (I, A)

MR imaging in a patient with an MR conditional system should always be performed in the context of a rigorously applied standardized institutional workflow, following the appropriate conditions of use. (I, B-R)

It is recommended for patients with an MR conditional system that personnel with the skill to perform advanced cardiac life support, including expertise in the performance of CPR, arrhythmia recognition, defibrillation, and transcutaneous pacing, be in attendance with the patient for the duration of time the patient’s device is reprogrammed, until assessed and declared stable to return to unmonitored status. (I, B-R)

It is recommended for patients with an MR conditional system that ECG and pulse oximetry monitoring be continued until baseline, or until other clinically appropriate CIED settings are restored. (I, A)

All resuscitative efforts and emergency treatments that involve the use of a defibrillator/monitor, device programming system, or any other MRI-unsafe equipment should be performed after moving the patient outside of Zone 4. (I, C-EO)

It is recommended for patients with an MR conditional system that personnel with the skill to program the CIED be available as defined by the institutional protocol. (I, C-EO)

It is reasonable to perform an MR scan on a patient with an MR conditional system implanted more recently than the exempt period for conditionality of the system, based on assessment of risk and benefit for that patient. (IIa, C-EO)

It is reasonable for patients with an MR nonconditional CIED system to undergo MR imaging if there are no fractured, epicardial, or abandoned leads; the MRI is the best test for the condition; and there is an institutional protocol and a designated MR-responsible physician and CIED physician. (IIa, B-NR)

It is reasonable to perform an MR scan immediately after implantation of a lead or generator of an MR nonconditional CIED system if clinically warranted. (IIa, B-NR)

For patients with an MR nonconditional CIED, it is reasonable to perform repeat MRI when required, without restriction regarding the minimum interval between imaging studies or the maximum number of studies performed. (IIa, C-LD)