Leads and MRI's

I had a Boston Sci pacemaker removed in Feb 2022 replaced with a Boston Sci ICD  Vigilant. However, I have 2 Boston Sci leads and 1 Medtronic. Have been refused an Mri of my head and neck because of this when all are supposed to be compatible. Never told why the use of different leads. Any ideas?


8 Comments

Check around

by sgmfish - 2022-04-05 17:11:24

I've have "approval issues" with MRIs. I can't tell with certainty, but I have my opinions. In the end I have gotten the MRIs I've needed, but not necessarily at the institution I wanted. It takes several providers to agree, and I've found lots of miscommunication or missing communication occurs. My opinion is that many institutions (e.g., hospitals) are afraid of the liability if something might go wrong with your pacemaker during an MRI. Their solution? Simply refuse to do them. Unless you have a very old PM, today's PMs are compatible with MRIs. It will take a PM techician to set your PM's settings to the basic level during the MRI, and then to restore your particular settings afterwards. My solution was to be the communication link between all the providers and insist that there is a way to get it done. Once I got the cardiologist to sign off on it (literally a piece of paper), then the hospital did it (although I had to go to a hospital out of my area; my local hospital simply refused under any circumstance).

Furthermore, my guess is that there is nothing wrong with you having different manufacturers for your leads, but it just doesn't fit the scenarios the MRI provider normally sees, so once again the liability issue rears its ugly head.

Leads and MRI's

by MrsGrudgemeyer - 2022-04-05 17:39:00

Thank you sgmfish. I believe my situation is exactly as you state. It's very easy to say no first.  I will check with my cardiologist and see if I can get the parties involved to communicate with each other.  I know my icd and leads are MRI compatible so I wasn't expecting it to be such a big deal, but I am learning it is not that simple! Thanks again!

MRI "compatible"

by AgentX86 - 2022-04-05 20:21:18

First, there is no such thing as a "MRI compatible" pacemaker.  They are "MRI conditional" and the primary condition is that the leads match the pacemaker. Yes, the issue is liability but not really what's being discussed here.  The FDA approves implantable devices and part of the approval process is testing.  There isn't a lot of motivation for Medtronic to test leads from Bston Sci, or verse visa, so it doesn't get done. There is nothing for the FDA to approve. The radiologist is the one who has to assume the liability for doing a medical procedure that isn't FDA approved.  Some will, most won't take that risk.  I've had the problem even when everything is from the same set of components (original installation).

Leads from different vendors can be difficult

by crustyg - 2022-04-06 12:59:50

My EP-doc fitted me with a suite from BostonSci (he was being nice and implanting the best PM for SSS+CI for keen road cyclists).  He doesn't usually use them and judging by the not very soft cursing as he struggled with the leads he won't hurry to use those leads again (I was fully awake, all done under local).  Some of this is lack of familiarity, some is genuine difference between vendor kit (shape of curve, smoothness as lead is fed through sheath etc.)

I suspect that your Medtronic lead is the additional one for the ICD, and from what little I know of these rather special leads, your EP-doc has deliberately chosen a lead that (s)he is familiar with and finds it 'easy' to implant.  And that's how you've ended up with components from more than one vendor.

Crusty

by IAN MC - 2022-04-06 14:36:48

In an ideal world the decision on which model of PM to implant would always be made on clinical grounds. Ideally the patient's medical condition and life-style would always be taken into account.

I suspect that this is rarely the case. I asked my PM tech why I was given a Medtronic and his answer was  "probably because we had lots of Medtronics in stock at the time " . The original poster may have ended up with one Medtronic lead for a similar non-scientific reason.

I was interested by your underlying suggestion that some makes of PM may be perceived to be easier to implant than others.....I guess it comes down to  familiarity .

Interestingly, I have had 2 MRI scans in the past year and have met very little difficulty in persuading the relevant doctors of the safety of the procedure. I think attitudes towards doing MRI scans on PM patients are changing (albeit slowly )..

Perhaps if litigation was as common here in the UK as it is across the pond then progress would be even slower !

Ian

Ian Mc

by sgmfish - 2022-04-06 15:40:24

Count yourself lucky that you live in a country with a national health system. Here in the USA each provider might as well be a independent kingdom. They have almost no procedures to coordinate when different providers are involved. Then the insurance company gets involved too. In my case, it took me a year just to get the insurnace company to agree that it made sense to MRI my knee in spite of the fact that the orthopedist was 100% convinced it was necessary (one of 3 MRIs I've had since the PM was installed). The communications in our system can be unbelievably screwed up, not to mention that each provider has his/her own rules and standards (much less different computer software, etc, etc, etc). BTW, in my experience it is not the safety of the procedure that is in question, it's who will foot the bill and/or go to court if something goes wrong.

MRI and different mfg leads

by islandgirl - 2022-05-03 23:29:23

I just had my Medtronic ICD replaced with a St Jude/Abbott CRT-D.  2 leads are Medtronic, 1 St Jude/Abbott.  I have to now go to the university hospital as the hospital I went to for MRIs won't do them with the different leads. I found out after I had the replacement.  They are all MRI conditional. 

okay so since we are on this topic

by dwelch - 2022-05-04 01:39:42

I have 35 year old leads from one brand (one broken but still connected ot the heart) 28 year old from another and another a few years old from another brand.  and a few year old pacer.   Im sure nobody is running around testing 35 year old leads with modern mri machines correct?  the rule when I got my first one was no mri.  I have no real desire, understand the physics and electronics side of it, not realy intersted there either.  But seeing this question, I probalby dont have to worry about it I would struggle to find someone to accept the liability...yes?

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