AGH Cardiologist Co-authors New England Journal of Medicine Article Detailing Safety of MRI for Patients with Implantable Cardiac Devices
Thursday, February 23, 2017
PITTSBURGH, Pa. — The results of a major study on the safety of magnetic resonance imaging (MRI) as a diagnostic procedure for patients with implantable cardiac devices were published today in the prestigious New England Journal of Medicine. Robert Biederman, MD, Medical Director of the Cardiovascular MRI Center at Allegheny General Hospital’s Cardiovascular Institute, co-authored the study. AGH, part of Allegheny Health Network (AHN), was one of just 19 medical centers nationwide to participate in the study – and the only hospital in western Pennsylvania.
The study, performed from 2009 to 2014, examined a total of 1,000 pacemaker and 500 implantable cardioverter defibrillator (ICD) cases using MRI. Researchers reported no deaths, lead failures or ventricular arrhythmias.
“MRI is simply too important a diagnostic tool not to be able to have it in our arsenal to evaluate and help determine the best treatment for patients who have implanted devices,” said Dr. Biederman. “For years, we had what are essentially two life-saving technologies – MRI and implantable devices – that could not be in the same room together. The findings of this study, though, should help solve this critical dilemma. Hospitals like AGH with advanced capabilities can safely perform MRI on this patient population.”
The New England Journal of Medicine article states that an estimated 2 million people in the U.S. and additional 6 million worldwide have implantable cardiac devices that, until now, would have been considered incompatible with MRI because of concerns that the powerful magnetic and radio frequency fields generated during MRI might damage the implanted device and harm the patient. The study also notes that at least half of those patients are expected to require an MRI at some point during their lifetime.
Patients with implanted cardiac devices who are referred for MRI undergo an extensive evaluation of their cardiovascular health and level of device dependence. Once a patient is cleared to undergo MRI at AGH, Dr. Biederman and his team perform a baseline device interrogation and then convert the pacemaker to a safer mode of operation for the length of the test. If patients are determined to be non-pacemaker dependent under baseline conditions, the device may be turned off completely while the imaging takes place.
During the procedure, a patient’s heart rhythm is monitored in real-time in the MRI suite and the entire process is closely supervised by Dr. Biederman, a cardiovascular physicist and the Cardiovascular MRI Center’s team of nurses and technologists. Once the MRI is completed, the implanted device is reprogrammed to its original settings.
In a subsequent study conducted at AGH, Dr. Biederman found that MRI is not just safe for patients with implantable cardiac devices, but also effective. The research, believed to be the first ever focused solely on the value of MRI in this patient population, was presented last year at the annual Society of Cardiovascular MRI Scientific Sessions meeting in Los Angeles.
“This ongoing study has shown that using MRI on patients with implanted pacemakers and defibrillators has added substantial clinical value to patient diagnosis and subsequent patient management, justifying the risk of the procedure,” said Dr. Biederman.
AGH specialists evaluated 157 patients, including 114 neurology/neurosurgery cases, 36 cardiovascular cases and seven musculoskeletal cases. For 88 percent of the neurology/neurosurgery cases, the MRI scan added value to the final diagnoses – with 18 percent of those cases seeing a change to the original diagnoses thanks to the use of MRI. And 92 percent of the cardiac cases saw a benefit from the use of MRI, while 100 percent of the musculoskeletal cases realized a benefit from using MRI. Additionally, Dr. Biederman reported, there were no adverse clinical events associated with it for any of the patients studied.