Cardiac Implantable Electronic Device Magnetic Resonance Imaging Registry

This Registry is an investigator initiated project designed to follow in the footsteps of the MagnaSafe Registry. MagaSafe was initiated to determine the risks of performing MRI for patients with pacemakers and Implantable Cardioverter-Defibrillators (ICDs). The latter is closed to new enrollments as of April 2014; however, there is still a need to accumulate data on these devices. There is also a significant clinical need, in that patients who are insured by CMS are currently excluded from having MRI scans if they have a pacemaker or ICD. The only option available to them is to undergo removal of their entire system, have the MRI scan, and then have a new system implanted. This is impossible for many patients who are "pacemaker dependent". It also exposes the patient to a well-known risk of complication from the removal/extraction process as well as the re-implant procedure. This must be contrasted to the negligible risk of having an MRI scan with the device in place (assuming proper precautions are taken), based on MagaSafe data as well as a large body of supporting literature.

Magnetic resonance is the imaging modality of choice for the diagnosis of many diseases of the brain, spinal cord, and musculoskeletal system. For some disease states, no acceptable alternative diagnostic imaging method is available. MRI is not only a superior imaging and diagnostic modality for many disorders, but also does not expose patients to ionizing radiation as does CT. The number of patients living with permanent pacemakers or ICDs is well into the millions (some estimates are up to 4 million in the US), and continues to increase. Likewise, the use of MRI continues to rise annually in all patient groups, however, as people advance in age, they are the most likely to need an MRI scan. As the device population is disproportionally weighted towards the older population, it is exactly this group that has the greatest need for MRI scans, yet may be denied.

As noted in the MagnaSafe information, "To provide optimal care to the increasing number of patients with an implanted cardiac device, health care professionals must have the capability to perform MR imaging with minimal risk and full knowledge of the possible complications." This registry recreates the protocol, safety monitoring and follow up in a manner very similar to other registries. The intent is to provide not only data that will hopefully continue to support the use of MRI scanning in device patients, but to allow this essential imaging technique to be available to patients without the need to expose them to 2 otherwise unnecessary procedures of removal and replacement of the implanted device.

This is a physician and institutional based registry that will start with New York University Langone Medical Center as collaboration between the Division of Cardiology (Electrophysiology Section) and the Department of Radiology (MRI imaging section). It is anticipated that additional sites may join in the registry over time, FDA permitting. The protocol is based on the widely published "Hopkins protocol" as attached to this submission. Several thousand patients have safely been scanned using this technique which emphasizes patient safety. Patients are monitored by experienced device personnel (ACLS certified) for vital signs (non-invasive blood pressure monitoring, pulse oximeter, and cardiac rhythm monitor (EKG)) while performing scans on patients with implanted devices. Scans are done at a major medical center equipped to manage any device or heart rhythm based complication should one occur. Only patients for whom no other imaging technique will provide adequate information are allowed to be scanned. The latter must be attested to by the physician who requires the information, and agreed upon by the electrophysiologist and the radiologist. IRB approval and a written investigator agreement will be required of any centers that may eventually participate in this registry.