8 Single centre review of magnetic resonance imaging (MRI) in paediatric patients (<18 yrs) with cardiac implantable electronic devices (CIEDs)

Introduction Guidelines have been developed by the Heart Rhythm Society, Joint British Societies and other national societies for performing MRI in patients with CIEDs. All exclude specific guidance for children, due to theoretical risks of harm in smaller body size with predominantly epicardial leads from in vitro studies. Although evidence is growing for epicardial systems there remains a paucity of published evidence for the safety of MRI with CIED in the paediatric population and no clear recommendations. Our primary aim was to elicit the feasibility and safety of MRI in paediatric patients with CIEDs at our centre within the last 10 years. Materials and Methods Retrospective review of all patients under 18 years of age who underwent MRI with a CIED at a tertiary cardiac centre. No scans were performed under sedation or general anaesthetic. All scans were performed at 1.5 Tesla in Normal mode with SAR<2 W/kg and pacing parameters were altered for the duration of the scan in accordance with local guidelines. Adverse events were defined as a significant change in lead impedance, battery life or physical symptoms. Results 12 children between 10–17 yrs, mean 14.3 yrs, with CIED underwent MRI. No patients were pacemaker dependent. 14 scans were performed with no adverse events. Mean length of scan 49 mins (IQR 43–60). Mean BSA 1.59 m2 (IQR 1.37 – 1.69). Discussion All scans were performed without adverse events demonstrating an acceptable safety profile for appropriately selected paediatric patients with CIED, provided local guidelines are strictly adhered to. Within this group, there were no patients under 10 ys, no abdominal generators, and only 1 epicardial lead. 28% of scans did not provide diagnostic information with significant artefact obscuring the region of interest, notably, S-ICD generators obscured most of the left ventricle for 2 cardiac MRI. Conclusion Although predominantly limited to endocardial or subcutaneous systems in older children, this data contributes to the growing evidence of safety in performing MRI scans for children with CIED, despite theoretical concerns about increased adverse effects with lower weight/BSA. However, significant generator-related artefact can reduce the diagnostic utility of cardiac MRI. Further safety and imaging data to better inform patient selection is desirable. References Indik JH, Gimbel JR, Haruhiko A, et al. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017;14(7) doi:10.1016/j.hrthm.2017.04.025 Bhuva A, Charles-Edwards G, Ashmore J, et al. Joint British society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices. Heart 2022;0:1–17. doi:10.1136/heartjnl-2022-320810. Vigen KK, Reeder SB, Hood MN, et al. JMRI-ISMRM Recommendations for imaging patients with cardiac implantable electronic devices (CIEDs). J Magn Reason Imaging 2020. Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American heart association scientific statement from the committee on diagnostic and interventional cardiac catheterization, council on clinical cardiology, and the council on cardiovascular radiology and intervention: endorsed by the American college of cardiology foundation, the North american society for cardiac imaging, and the society for cardiovascular magnetic resonance. Circulation 2007;116:2878–2891. Verma A, Ha AC, Dennie C, et al. Canadian heart rhythm society and Canadian association of radiologists consensus statement on magnetic resonance imaging with cardiac implantable electronic devices. Can Assoc Radiol J 2014;65:290–300.

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