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Off‐Label MRI in 2017 of CIEDs: A Daily “Fork‐in‐the Road” for Implanters and the Case for Common Sense
Author(s) -
GIMBEL J. ROD
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13056
Subject(s) - medicine , citation , fork (system call) , library science , cardiology , nuclear medicine , computer science , operating system
In this issue of PACE, Emory University reports their experience of both magnetic resonance (MR) imaging (MRI) of non-MRI-conditional devices (often called, “legacy devices” or “offlabel MRI”) and MRI-conditional devices.1 Using the metric that any difference in outcomes of offand on-label MRI only be considered relevant if “clinically actionable,” Shah et al. conclude “the findings presented may suggest equivalent low clinical risk when MR imaging is performed in patients with MRI-conditional and non-MRconditional devices, under the specific protocol utilized.”1 In their series of 96 off-label scans, small nonsignificant lead parameter changes did not require lead revision or programming changes and no device reset, or device failures were observed. Shah et al. note that the average time from implant to MRI was 3 years emphasizing the importance that clinicians who must choose which device to implant today have impact on their patient’s future access to MRI.1 While only a comparatively small series of patients were evaluated, the authors show that a standardized protocol developed by experts elsewhere2 can translate well to another center (Emory) allowing safe off-label MRI of device patients. Others are implementing the eponymous “Hopkins Protocol” in a like fashion.3 This signals to other institutions that they might embrace well vetted “recipes for off-label scanning” should they wish to start scanning patients with non-MR-conditional devices. Encouragingly, such protocols may provide a foundation to help break down professional and institutional barriers that may exist among radiologists and hospital administration regarding the adoption of needed off-label scanning programs. Additional guidance will arrive with the release of the upcoming “HRS Expert Consensus Statement on MRI and Radiation Exposure in Patients with CIEDs” expected in the spring of 2017, likely with areas of controversy remaining after its publication.