Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator

Robert Russo, M.D.; NEJM 2017; 376: 755-764


The old adage: a pacemaker means no MRI, is becoming passé.  FDA-approved conditional pacers are MRI friendlier, and a handful of studies have shown that MRI can be performed safely in non-conditional pacemakers or defibrillators.

This case series followed 1500 patients with non-conditional pacers and defibrillators, from a variety of manufacturers, who underwent non-thoracic MRI at 1.5 tesla.

The study patients went through a strict pre- and post-MRI device interrogation and re-programming algorithm.  Device and lead failure did not occur in a single patient during the six month follow-up period.  Six patients had transient atrial fib/flutter and six had partial electrical reset.

Take home: if your MRI team is able to follow the meticulous interrogation, re-programming, and restoration protocol for the devices; if your MRI is 1.5 tesla; if you are not doing a thoracic MRI…then you might feel a bit better about a pacer or defibrillator surviving, relatively unscathed, an encounter with an MRI.