MRI Access Expands for People with Cardiac Devices

Researchers at the University of California, Los Angeles (UCLA) are making MRI a possibility for the nearly three million Americans living with implanted cardiac devices, such as pacemakers and other cardiac implantable electronic devices (CIEDs).

“One of the biggest challenges in radiology was imaging patients with cardiac devices, who are generally older individuals with more comorbidities,” said presenter Arash Bedayat, MD, associate professor at UCLA. “These are often elderly patients with other health issues. Without this program, MRI scanning simply wouldn’t be an option for them.”

Acknowledging the complex interplay between device hardware and MR environments, Dr. Bedayat addressed the challenge of the heat generated by routine MRI sequences. “The powerful magnetic field of the MRI may also interfere with the operation of the devices, potentially causing them to malfunction and endangering the patient,” he said.

Over a ten-year period, UCLA implemented a workflow using wide-band MRI sequences in 7,324 people with CEIDs to reduce hyperintensity artifacts and mitigate device interference. It resulted in a marked increase in annual scan volume which grew from 181 in 2015 to 1,224 in 2024, underscoring both the clinical demand and the operational feasibility of advanced imaging protocols for this complex population.

MRI Workflow: Protection Modes and Monitoring

Dr. Bedayat described the study’s workflow as a collaboration between radiology and cardiology. “All patients underwent rigorous pre-scan screening and device protection and were monitored continuously throughout the procedure,” he said.

A chest X-ray was performed to assess the type of device and lead configurations, and electrophysiologists were consulted to evaluate potential risks. “Implanted devices were switched into protection mode before the scan began,” Dr. Bedayat said. “Continuous rhythm monitoring during scanning and post-scan was conducted by a nurse practitioner, and at the conclusion of the study, devices were programmed to resume normal functioning.”

Dr. Bedayat noted that the most common clinical indications for MRI in the study were neurologic (54.3%), gastrointestinal/genitourinary (16.4%), cardiac (15.6%) and musculoskeletal (11.2%). “Only 18 major adverse events were recorded, underscoring the success of the rigorous protocols we put in place to monitor and protect patients throughout the procedure,” he said.

According to Dr. Bedayat, the study results represent a significant leap forward in the safe use of MRI for patients with cardiac devices. “With the implementation of a standardized protocol and multidisciplinary oversight, MRI can be performed effectively and safely in patients with cardiac devices,” he said. “We have dedicated up to 20 outpatient time slots each week at our center for patients with CIEDs, and have a waiting list of approximately six to eight weeks.”

Dr. Bedayat also stressed the broader implications of the study’s findings, noting that the adoption of similar MRI programs at other medical institutions could eliminate unnecessary restrictions on imaging for patients with cardiac devices. “Expanding such protocol-driven MRI programs across institutions can eliminate unnecessary restrictions and ensure equitable, evidence-based care for all CIED patients,” he said.

“Our ten-year institutional experience demonstrates that rigorous screening, device programming, and monitoring minimize risks and enable broader access to essential imaging,” Dr. Bedayat concluded.

Access the session, “MR Imaging in 7,324 Patients with Implanted Cardiac Devices: A 10-year retrospective Cohort Experience,” (S5-SSCA02-1) on demand at RSNA.org/MeetingCentral.