12
Management of Patients with a CIED
Referred for MRI
Figure 2. Checklist for MRI Safety in the Setting of Implanted
Devices (PM or ICD)
SECTION 1 – GENERATOR INFORMATION
PM ICD
☐ Yes ☐ No ☐ Yes ☐ No
Manufacturer & Model # Manufacturer & Model #
SECTION 3 – MR CONDITIONAL STATUS AND MANAGEMENT
MR Conditional System?
Pre-MR imaging pacing/tachycardia mode activated? ☐ Yes ☐ No
☐ Monitor ECG and pulse oximetry by ACLS-trained personnel during the time the
patient's device is reprogrammed and until assessed and declared stable to return to
unmonitored status.
☐ Keep external defibrillator and CIED programmer available (outside of zone 4).
☐ Conform to CIED manufacturer MRI recommendations including field strength,
maximum estimated SAR, gradient slew rate, and transmit/receive coil.
If the MR Conditional System was implanted less than the exempt period for
conditionality (e.g., 6 weeks), is the MRI scan considered clinically useful based on
assessment of risk and benefit for that patient? ☐ Yes ☐ No
MR Nonconditional System:
• It is reasonable to perform MRI if the following conditions are met:
• No fractured, epicardial, or abandoned leads
• MR is the best test for condition
• Institutional protocol in place
• Designated MR-responsible physician and CIED physicians
Pacing Dependent
☐ Yes | ☐ No
☐ If yes, CIED must have asynchronous (VOO/DOO) pacing capability.
☐ Program pacing to VOO/DOO.
Deactivate tachycardia detection and therapies.
☐ If programming VOO/DOO and there is an underlying rhythm, program the
pacing rate faster than the underlying rate to avoid competitive pacing.
☐ Deactivate magnet, rate & noise response, and all advanced features.*
☐ Monitor ECG and pulse oximetry by ACLS-trained personnel during the time the
patient's device is reprogrammed and until assessed and declared stable to return to
unmonitored status.
☐ Keep external defibrillator and CIED programmer available (outside of Zone 4).
* All nonessential features that do not support fundamental backup pacing support if necessary
during MRI should be disabled. ese include: PMT algorithms, PVC and PAC triggered
pacing response, hysteresis, rate smoothing, overdrive pacing, and conducted AF response. For
CRT patients, deactivate LV-triggered pacing (ventricular sense response).
