MRI and pacemaker

Hello all,

I received my pacemaker 7 years ago this summer.   I expect that possibly later this year I would have to have my pacemaker and/or battery replaced.

Recently I have had ACDF surgery for cervical radiculopathy.  I also have lots of other spine issues including my lumbar spine.  Because with my current PM I could not have an MRI, I had to make do with CT scans and a myelogram.   My spine surgeon (and a 2nd opinion) basically said that was enough, they could clearly see my bulging discs and bone spurs etc.  (I had 3 level ACDF).

The problem is that this surgery has NOT helped me, and if fact the nerve pain and numbness is worse down my right hand/arm.   They tell you it might take a year to get better, but even my surgeon clearly expected I would at least get some relief, and I would venture that like me, he wonders if something else is going on that was missed.

So to sum up, I would like to be able to ask my cardiologist to replace both the pacemaker AND the leads, as I  have read that the leads themselves are what make the PM not compatible with the MRI.

Has anyone else been in this situation?  What should my expectations be?  Will it come down to insurance?  I have Medicare and the United Healthcare supplement, which is very good.

Thanks in advance.. 

Mitch


8 Comments

New leads

by AgentX86 - 2022-06-20 19:10:34

The new PM and old leads probably won't meet the conditions of the FDA certification but it's up to the radiologist whether to do the MRI or not.  They're usually very conservative so probably won't want to take the chance with old leads that aren't MRI conditional at all. You won't know until  the issue comes up.

Replacing the leads is matter of getting Medicare to pay for it.  If they pay their share then your supplemental policy has to cover the rest. Your EP and orthopedic surgeon may have to gang up on Medicare to convince them that it's a medical necessity.  I don't know if they're going to think it important enough but it's probably worth pursuing.

T hanks

by LiveFreeOrDie - 2022-06-20 19:47:36

I will be raising this with both my cardiologist and neuro/spine surgeon..  I realize they may need to go to bat for this.   Not being able to have ANY MRIs is pretty bad for almost all diagnostic stuff nowadays.

MRIs

by AgentX86 - 2022-06-20 22:45:52

You might have a chance if both are motivated.  Note that just because you have all matching "MRI conditional" hardware doesn't mean it'll be any fun actually getting an MRI.  I had one hospital simply refuse and another took their sweet time to agree, and that was after the clearance by my cardiologist.  They don't like pacemakers at all.  It's a simple procedure but they have to get everyone together  (imaging and PM techs) to actually do the work.  It has to be done in a large hospital that also has a cardiac facility.  It is a RPITA on a good day.

If it's needed...

MRI

by Tracey_E - 2022-06-21 10:09:03

If your device is less than 10 years old, there are hospitals that will do an MRI. They've been doing it in Europe with no issues whatsoever, and it's getting more common in the US. They'll always try CT first, and you might have to do your homework to find a hospital that will take you, but it can be done safely. I know more than one person who has had an MRI with an older pacer, one who has had multiple. 

Having MRI-safe leads and box doesn't mean you can go just anywhere to have an MRI. You'll still have to find a facility willing to deal with it, and there are protocols to follow. 

You've had your leads long enough that it would take an extraction surgery to get them out. You'll want a specialized surgeon to do that. It's no longer considered a high risk procedure when done by an experienced surgeon, but it's also not an easy one with no risk. I personally would not do it unless I'd exhausted my other options. Getting new leads isn't going to make it as easy to get an MRI as you might think so it may not be worth it between the hoops you'll have to jump through to get insurance to pay for it, and the surgery itself. 

Sad

by ROBO Pop - 2022-06-21 16:43:00

It deeply saddens me how these fairy tales continue to perpetuate themselves. Having an MRI with a pacemaker or defibrillator is safe no matter the age of your device or leads. Better hospitals have proper protocols for the procedure. "MRI" safe devices are a marketing ploy. Next you'll be telling me someone won the election

https://www.dicardiology.com/article/mri-can-be-safely-performed-patients-pacemakers-and-icds

Sad?

by AgentX86 - 2022-06-21 22:49:04

Emory Hospital in Atlanta was a pita even with my MRI conditional setup that they implanted. I went to another more local hospital and even that was a PITA but it was easier to jump through the hoops (easier to get there).

Dartmouth Hitchcock in New Hampshire wouldn't touch me either. They sent me home (1200mi) with "don't drive" instructions.

It is *not* a fairy tale. Yes, it's possible but you're really going to have jump through hoops and could easily be told to get lost.

MRI

by islandgirl - 2022-06-21 23:35:08

It's a difficult road.  The hospital I had gone to for an MRI with an ICD (with lots of hoops to jump through with my EP's office) will no longer perform and MRI because I have a new device and 3rd lead--a different 2 leads are Medtronic, 1 lead and new device St Jude/Abbott.  My leads are about 8 years old and are MRI conditional.  The university hospital will do an MRI but they told me they have to weigh the risks vs. the benefits.  The hospital I had my new device inserted in January only has a contract with St Jude/Abbott.  I woudl have switched hospitals if I knew of the incompatibility.  

Ask your EP/cardiologist for help.

 

ACDF

by Mike417 - 2022-06-26 19:09:10

Mitch,

I feel for you.  It has been nearly 2.5 years since I had ACDF, C3-C6.  I had my PM placed 4 weeks before that.  Then 6 months after that I had surgery L4-L5 for spinal stenosis!  I feel for you that you are still having pain down your arm; have you tried wearing a collar?  There could still be impingement on the nerve.

Ask you doc if will do a phone consult with Medicare and the secondary insurer to see if they will swap it out for a MRI compatable PM.

Mike

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