Thread by @AnnaGiuliaPavon

#whyCMR and Implantable devices:

👉Increasing rates of cardiac device implantation
👉Expanding indications for CMR

Need to deal with:
🥇Device compatibility
🥈Artifacts
🥉Stress perfusion

…where are we?
💫Here a tweetorial on CMR and devices!

Conditional or non conditional?

👉1.5T or 3T
👉 no deaths, lead failures, losses of capture, or ventricular arrhythmias during CMR in patients with non-MR conditional pacemakers or ICDs
👉only decrease in 1% in p wave amplitude (no clinically relevant)

What about abandon leads?

👉No major tachicardia
👉No major device malfunctioning
👉reports show that this should not be a controindication anymore

What about Artifacts?

👉Artifacts depends on:

🥇Number of leads
🥈Dimension of the generator
🥉Distance heart-generator

Loop recorder<PM<ICD<CRT-D
🚩LGE can suffer more from artifacts compared to cine or perfusion

Tips and Tricks for artifacts:

🚩See device position on scout images
🚩See artifacts on scout images
🚩Use GRE-cine or GRE-perfusion
🚩Use wideband LGE

Stress perfusion (SP) CMR:

👉SP CMR yields good image quality in patients with PM

👉SP CMR can help defining the prognosis of patients with PM

👉SP CMR yields good image quality also in patients with ICD

👉SP CMR is feasible and safe even in patients PM dependent

🥇check compatibility vs CMR indication (🚩 no issues reported for non conditional)

🥈check the device before scanning --> MR mode:
🧐 turn off ICD
🧐PM should be activated if >1% of atrial/ ventricular pacing
👉dont' be afraid of SP CMR!

🥉Turn off the MR mode after scanning

Bibliography: some useful papers, feel free to add!

pubmed.ncbi.nlm.nih.gov/35022037/
pubmed.ncbi.nlm.nih.gov/34274281/
pubmed.ncbi.nlm.nih.gov/34435642/
pubmed.ncbi.nlm.nih.gov/34031214/
pubmed.ncbi.nlm.nih.gov/31776746/
pubmed.ncbi.nlm.nih.gov/21641356/
pubmed.ncbi.nlm.nih.gov/30642645/
pubmed.ncbi.nlm.nih.gov/34378816/

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