Allied Professionals (Non-physician submissions only) -> Clinical Research D-PO02 - Poster Session II (ID 47) Poster

D-PO02-042 - Pacemaker Checks Peri-MRI Scan Impose Significant Burden On Clinician Workflow (ID 173)


Background: Most modern cardiac implanted permanent pacemaker (PPM) systems are now compatible with magnetic resonance imaging (MRI) scans subject to pre-specified conditions. PPM checks are requested to fulfill MRI scan requirements. We sought to determine its impact on cardiac physiologist workflow in a tertiary hospital over a 12-month period.
Objective: To assess the impact of peri-MRI scan PPM checks on clinician workflow.
Methods: PPM checks for patients undergoing MRI-scans at our institution over a 12-month period until 1st September 2018 were analyzed. We evaluated all relevant PPM check reports in conjunction with PPM interrogation PDF files to determine incidence of PPM issues and programming modes. We also determined the amount of time spent on such checks including when they were performed (After-hours defined as weekends or between 5pm and 8am during weekdays).
Results: 71 MRI scans were performed in 63 patients with PPM (65% male, mean 74±12 years old, six patients had two scans and one had three scans) during the 12-month period. Few PPMs had auto-MRI detection capabilities but were not utilized per department policy. Consequently, all had pre- and post-MRI scan PPM check (n=142 checks). MRI mode programming was documented for 64 scans with asynchronous pacing enabled in 95% (n=61) and pacing disabled in 5% (n=3) scans. The mean time difference between checks was 70±32 minutes. No MRI scan resulted in PPM (device or lead) malfunction. Necessary permanent PPM programming optimization was performed during PPM check for 3 scans only. On one occasion, a sustained atrial arrhythmia began whilst asynchronous pacing had been enabled. There was an increasing need for peri-MRI device checks by quarter (Q1; n=11, Q2; n=11, Q3; n=23, Q4; n=26). Seven scans (9.9%) were performed after-hours.
Conclusion: Peri-MRI PPM checks are adding additional burden to cardiac physiologists’ workflow, including after-hours time. Availability of Auto-MRI mode, although not utilized presently in our institution, is anticipated to increase as more newer generation PPMs are implanted. New pathways and model of care are required to improve workflow efficiency.