6 Safety of magnetic resonance imaging in patients with abandoned epicardial pacing leads and carcinoid heart disease

<h3>Introduction</h3> Magnetic resonance imaging (MRI) plays an integral role in the diagnostic work-up of patients with carcinoid disease. Current guidelines, however, advise caution when performing MRI in patients with abandoned epicardial leads due to the higher theoretical risk of heating and adverse events. Most studies of non-MR conditional scans excluded patients with abandoned epicardial leads; there are less than 50 reported cases in the literature. In this single-centre study, we therefore sought to assess the safety of MRI in patients with abandoned epicardial leads and carcinoid heart disease. <h3>Materials and Methods</h3> We retrospectively identified a total of 13 MRIs over a 10-year period performed in 5 patients with carcinoid heart disease and abandoned epicardial leads. Prior to each MRI, requests were vetted in advance by a multidisciplinary team including cardiology, radiology and the referring specialty before obtaining patient written consent. The MRI regions included 7 cardiac, 4 liver, 1 brain, and 1 spine. All studies were undertaken on a 1.5-T MRI scanner (Siemens Avanto) with estimated whole-body averaged specific absorption rate &lt;2.0 W/kg. Studies were performed with a level 3 cardiovascular magnetic resonance cardiologist present. We assessed the quality of the imaging, and the presence of adverse events defined as: chest pain, new atrial or ventricular arrhythmia, or CV-related admission within 30 days of the MRI. Specific criteria were followed to objectively define if the MRI information enhanced patient care. After scan interpretation and review of all pertinent clinical records, the MRI study was deemed clinically useful if it either: 1) provided additional information to the existing diagnosis, or 2) changed patient management. <h3>Results</h3> Out of the 13 MRIs, 10 (77%) were of good quality, 2 (15%) showed minor artefact and all examinations (100%) added value to diagnosis and patient management. There were zero adverse events. <h3>Discussion</h3> These preliminary data provide further evidence that MRI may be safe in patients with abandoned epicardial leads. These findings could facilitate broader use of MRI in such patients, enhancing diagnostic precision and improving clinical outcomes. <h3>Conclusion</h3> MRI in patients with abandoned epicardial leads appears safe so long as appropriate protocols are followed. Larger observational studies are recommended to confirm safety. <h3>Acknowledgements</h3> None.