Heart Rhythm Society Releases New Consensus Statement on MRI, Radiation Exposure

The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement in the United States on indications of patients who undergo magnetic resonance imaging (MRI) and radiation exposure with cardiovascular implantable electronic devices (CIEDs). The expert writing group presented the recommendations included in the 2017 HRS Expert Consensus Statement on Magnetic Resonance Imaging and Radiation Exposure in Patients with Cardiovascular Implantable Electronic Devices today at Heart Rhythm 2017, the Heart Rhythm Society’s 38^th Annual Scientific Sessions in Chicago, Ill.
 
There is an increasing number of people with CIEDs, and approximately 200,000 pacemakers are implanted in the United States each year.¹ Historically, MRI scanning and radiation exposure for patients with CIEDs has prompted concerns due to their unpredictable effects and interferences in safeness and overall function of the devices. Recent studies have suggested that MRI can be done safely in many patients with magnetic resonance (MR) conditional and non-conditional systems.
 
The expert consensus statement is intended to help frontline cardiologists, radiologists, radiation oncologists, and other healthcare professionals involved in the care of adult and pediatric patients with CIEDs. To further address the issue, the expert writing group also discusses the safety of employees with CIEDs who may come into an MRI environment. The document provides guidance on who would be suitable to undergo certain procedures and how to monitor the individuals who are exposed to:

• MRI
• Radiation exposure for CT scans; and
• Cancer treatment with radiation

 
“Oftentimes, healthcare providers may recommend removing a device before being exposed to radiation for cancer treatments because of existing safety concerns, but the removal of the device itself could pose risks to the patient,” says Julia H. Indik, M.D., Ph.D., a professor of medicine and director of Cardiovascular Disease Fellowship Program at the University of Arizona, Sarver Heart Center. “We hope that our recommendations will make decisions easier for clinicians and ensure we are delivering optimal patient care while setting the first-ever standard of individualized protocols for patients with these devices.”
 
The statement includes specific recommendations in the following areas:

•  Introduction and Methodology
•  Definitions of CIED Systems in Relation to MRI
•  MRI Technology and Relationship to Risk
•  MR Conditional CIED Technology
•  Management of the CIED Patient Referred for MRI
•  Management of the CIED Patient Undergoing CT Imaging
•  Management of the CIED Patient Undergoing Radiation Therapy
•  Future Directions

 
The members of the expert writing group performed a comprehensive electronic literature search and then developed a series of recommendations. This was done from randomized controlled trials, non-randomized observational studies, and case series to support useful and practical recommendations, given that each individual institution serves its patient population uniquely. The writing group also evaluated computational modeling and in-vitro and animal studies to explore and identify specific combinations that may pose a higher risk to patients, which cannot be determined by clinical studies alone.
 
The expert consensus statement was developed in collaboration with 11 international organizations: American Heart Association (AHA), American College of Cardiology (ACC), American College of Radiology (ACR), Asia Pacific Heart Rhythm Society (APHRS), American Society for Radiation Oncology (ASTRO), Council of Affiliated Regional Radiation Oncology Societies (CARROS), European Heart Rhythm Association (EHRA), Japanese Heart Rhythm Society (JHRS), Pediatric and Congenital Electrophysiology Society (PACES), Sociedade Brasileira de Arritmias Cardíacas (SOBRAC), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE).

The document was published today in the online edition of Heart Rhythm, the official journal of the Heart Rhythm Society.
 
Heart Rhythm 2017 is the most comprehensive educational program for heart rhythm professionals, featuring more than 250 educational sessions and more than 130 exhibitors showcasing innovative products and services. The Heart Rhythm Society’s Annual Scientific Sessions have become the must-attend event of the year, allowing the exchange of new vital ideas and information among colleagues from every corner of the globe.
 
The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 5,900 heart rhythm professionals in more than 70 countries around the world.