1. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society
- Author
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Christine Villemaire, James A. White, Matthew T. James, D. Ian Paterson, Michael D. Hill, Secondary Panel, Laurence D. Sterns, Kate Hanneman, Douglas Wan, Atul Verma, Carmen Lydell, Jonathan Windram, Craig Butler, Idan Roifman, Anish Kirpalani, Primary Panel, L. Grosse-Wortmann, Rachel M. Wald, Kim A. Connelly, Jonathon Leipsic, Andrew M. Crean, Elsie T Nguyen, Jaimie Manlucu, Bradley Sarak, Roopinder K. Sandhu, and Peter G. Guerra
- Subjects
Canada ,Pacemaker, Artificial ,medicine.medical_specialty ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,Inventions ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Canadian Cardiovascular Society ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Quality Improvement ,Defibrillators, Implantable ,Structure and function ,Heart Rhythm ,Safety profile ,Cardiovascular Diseases ,Nephrogenic systemic fibrosis ,Risk Adjustment ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
- Published
- 2021