10
Management of Patients with a CIED
Referred for MRI
Figure 1. Management Algorithm
Is the system
beyond the
exempt period for
conditionality from
time of implant?
NO
YES
• Standardized workflow in place
(I/B-R)
• Adhere to all product labeling
including activation of MR mode
and adherence to scanning
requirements (I/A)
• Monitor ECG and pulse oximetry
(I/A)
• Personnel with skills to perform
ACLS are present during the time
the patient is reprogrammed and
until assessed and declared stable
to return to unmonitored status
(I/B-R)
• Personnel with skill to program the
CIED are available as defined by
institutional policy (I/C-EO)
• Keep external defibrillator and
CIED programmer available
outside of Zone 4 (I/C-EO)
YES
Is the system MR
Conditional?
NO
MR reasonable to
perform depending
on assessment of the
patient's risk and benefit
(IIa/C-EO)
• If ICD, deactivate tachycardia
detection and therapies
(I/B-NR)
• Follow-up in device clinic in
3–6 months after MRI unless
earlier follow-up (within a
week) is indicated for the
following: Any capture
threshold increase >1.0 V,
sensing drop >50%, pacing
impedance change >50 Ω
or shock impedance >50 Ω
(IIa/B-NR)
