Background
Most modern cardiac implantable electronic device (CIED) systems are now compatible
with magnetic resonance imaging (MRI) scans. The requirement for both pre- and post-MRI
CIED checks imposes significant workload to the cardiac electrophysiology service.
Here, we sought to determine the burden of CIED checks associated with MRI scans.
Methods
We identified all CIED checks performed peri-MRI scans at our institution over a 3-year
period between 1 July 2017 to 30 June 2020, comprising three separate financial years
(FY). Device check reports, MRI scan reports and clinical summaries were collated.
The workload burden was determined by assessing the occasions and duration of service.
Analysis was performed to determine cost burden/projections for this service and identify
factors contributing to the workload.
Results
A total of 739 CIED checks were performed in the peri-MRI scan setting (370 pre- and
369 post-MRI scan), including 5% (n=39) that were performed outside of routine hours
(weekday <8 am or >5 pm, and weekends). MRIs were performed for 295 patients (75±13
years old, 64% male) with a CIED (88% permanent pacemaker, and 12% high voltage device),
including 49 who had more than one MRI scan. The proportion of total MRI scans for
patients with a CIED in-situ increased each FY (from 0.5% of all MRIs in FY1, to 0.9%
in FY2, to 1.0% in FY3). The weekly workload increased (R2=0.2, p<0.001), but with week-to-week variability due to ad hoc scheduling (209 days
with only one MRI vs 78 days with ≥2 MRIs for CIED patients). The projected annual
cost of this service will increase to AUD$161,695 in 10 years for an estimated annual
546 MRI scans for CIED patients.
Conclusions
There is an increasing workload burden and expense associated with CIED checks in
the peri-MRI setting. Appropriate budgeting, staff allocation and standardisation
of automated CIED pre-programming features among manufacturers are urgently needed.
Keywords
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References
- Trends in the use, complications, and costs of permanent pacemakers in Australia: a nationwide study from 2008 to 2017.Pacing Clin Electrophysiol. 2021; 44: 266-273
- 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices.Heart Rhythm. 2017; 14: 97-153
- Magnetic resonance imaging in non-conditional pacemakers and implantable cardioverter-defibrillators: a systematic review and meta-analysis.Europace. 2020; 22: 288-298
- Medicare Australia Statistics.([accessed 13.11.22])
Australian Government Department of Health. Primary Health Care 10 Year Plan – Stronger Rural Health Strategy - Improving rural access to magnetic resonance imaging (MRI) diagnostics. Online: Department of Health - Budget 2022-23; 2022. https://www.health.gov.au/sites/default/files/documents/2022/03/budget-2022-23-improving-rural-access-to-magnetic-resonance-imaging-mri-diagnostics.pdflast. [accessed 13.11.22].
- Access to magnetic resonance imaging of patients with magnetic resonance-conditional pacemaker and implantable cardioverter-defibrillator systems: results from the Really ProMRI study.Europace. 2018; 20: 1001-1009
- Need for MRI scans in a real-world CIED population over long-term follow-up: data from a large single-centre experience.PLoS One. 2020; 15e0244672
- Should we check it? Assessing interrogation of cardiac implantable electronic devices in the emergency department–The CHECK-ED study: implications for service planning and care delivery.Heart Lung Circ. 2022; 31: 1119-1125
- Magnetic resonance imaging in people with cardiac implantable electronic devices: a population based cohort study.Heart Lung Circ. 2018; 27: 748-751
- Real-world evaluation of magnetic resonance imaging in patients with a magnetic resonance imaging conditional pacemaker system: results of 4-year prospective follow-up in 2,629 patients.JACC Clin Electrophysiol. 2017; 3: 1231-1239
- Assessing the risks associated with MRI in patients with a pacemaker or defibrillator.N Engl J Med. 2017; 376: 755-764
- Safety of magnetic resonance imaging in patients with cardiac devices.N Engl J Med. 2017; 377: 2555-2564
- Utilization and programming of an automatic MRI recognition feature for cardiac rhythm management devices.Heart Rhythm O2. 2021; 2: 132-137
- Magnetic resonance imaging conditional pacemakers: rationale, development and future directions.Indian Pacing Electrophysiol J. 2012; 12: 204-212
- The Kora pacemaker is safe and effective for magnetic resonance imaging.Clin Med Insights Cardiol. 2015; 9: 85-90
- Remote control of cardiac implantable electronic devices: exploring the new frontier—first clinical application of real-time remote-control management of cardiac devices before and after magnetic resonance imaging.J Innov Cardiac Rhythm Manag. 2019; 10: 3477-3484
- MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model.BMJ Qual Saf. 2019; 28: 853
Article info
Publication history
Published online: November 25, 2022
Accepted:
October 7,
2022
Received in revised form:
October 1,
2022
Received:
August 8,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
