MR-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter‑Defibrillatoren: Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Röntgengesellschaft (DRG)

This joint consensus paper of the German Roentgen Society and the German Cardiac Society describes the physical and electrophysiological background and provides specific recommendations for the procedural management of patients with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD) undergoing magnetic resonance imaging (MRI). The paper outlines the responsibilities of radiologists and cardiologists regarding patient education, indications, monitoring, modification of MRI sequences and PM/ICD reprogramming strategies being discussed in particular.The aim is to optimize patient safety and to improve legal certainty in order to facilitate the access of SM/ICD-patient to MR imaging.The key messages of this paper are as follows: 1. Conventional PM and ICD system are no longer an absolute but rather a relative contraindication for performing an MRI examination. Procedural management includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific risks and “off label” use, extensive PM/ICD-related and MRI-related safety precautions to reduce these risks to the greatest extent possible, as well as adequate monitoring techniques. 2. MR conditional pacemaker and ICD systems have been tested and approved for MRI examination under specific conditions (“in-label” use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety. 3. The risk for an ICD patient during MRI examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems. The indication for an MRI examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/benefit ratio should be critically reviewed. 4. This complex subject requires close collaboration between radiology and cardiology.