Abstract 10610: The Additive Value of Pacemakers and Icds in the Mri Environment Over 18 Years; A Large, Prospective Observational Study

Introduction: MRI is infrequently performed on pts with conventional PM’s and ICDs. While many studies, including MagnaSafe , have unequivocally supported MRI safety in pts with such devices, the clinical value has rarely been considered. Accordingly, we performed an observational, prospective study to determine the 'Additive Value' beyond safety for pts with conventional PM/ICD undergoing clinical MRI. Hypothesis We propose that MRI in PM/ICD pts is crucial to an existing diagnosis and often, substantially alters diagnosis and subsequent management. Methods An MRI Device exam (GE 1.5T,WI) pioneered by cardiologists (>95% over 15 yrs) was performed. Subsequently, a series of defining questions using Boolean Logic Construct were answered within 1 week of MRI by both MRI technologist and MRI physicians: 1) Did the primary diagnosis change? 2) Did MRI provide additional information to existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If 'Yes' was answered to any of the above questions, it was considered that MRI was of value to pt diagnosisand/or impending therapy. Results: Avg MRI: 28±16min for 1678 consecutive pts of which 1271 (73%) were neuro/neurosurgery, 145 (8%) were musculoskeletal and 323 (19%) were CV cases. Upon review: of the neuro/neurosurgery MRIs, 1106 (87%) provided additional information. The diagnosis changed in 807 (73%), while medical therapy changed in 774 (70%). In only 135 (11%) did MRI simply confirm original diagnosis. For cardiac pts, MRI changed the original diagnosis in 213 (66%). MRI did not contribute in 97(14%) as it was uninterpretable (ICD artifact), while in 43 pts, the diagnosis did not change. Finally, in 145 musculoskeletal pts, MRI provided additional information in 139 (96%) and in 128 (88%), changed pt care, and in 3 pts (2%), simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any pt. Conclusions A dedicated program of utilizing MRI in PM/ICD pts adds substantial clinical value to diagnosis and subsequent management justifying inherent risk. We believe yet another impediment to the advancement of CMR-PM/ICD strategies can become routine and life-changing.