Magnetic resonance imaging in patients with implanted cardiac electrotherapy devices: a statement from experts of the Polish Medical Society of Radiology, the Polish Society of Cardiology, and the Polish Society of Electroradiology.

The year 2023 marks 60 years since the first pacemaker was implanted in Poland. The number of implantable cardiac electrotherapy devices (CIEDs), including pacemakers, cardioverter-defibrillators, and resynchronization therapy systems, has been systematically increasing in the subsequent decades. It is estimated that nearly 500,000 Poles have an implanted cardiac electrotherapy device, making optimal diagnostic imaging with the use of magnetic resonance imaging (MRI) a clinically and epidemiologically important issue. MRI has become a gold diagnostic standard in many disease states. In this situation, it is believed that 50-70% of patients who have a cardiac electrotherapy device may have indications for an MRI examination later in life. For many years, an implanted cardiac electrotherapy device was considered a definite contraindication to MRI. However, MRI has become possible in most patients with CIED if certain procedures and precautions are followed. In these guidelines, we describe the basic rules that should be followed in order to perform a safe MRI examination in patients with different CIEDs. Despite all the risks and organizational factors described in the text, it seems that for many MRI departments, MRI in patients with CIEDs is achievable and should be implemented immediately. A second important issue is the need for dedicated financial support for these procedures from public health insurance.

Abandoned Intracardiac Electrodes in an Oncological Patient.

Cardiological and oncological patients comprise the majority of patients admitted to the emergency unit with chronic or acute conditions that are the dominant cause of death worldwide. However, electrotherapy and implantable devices (pacemakers and cardioverters) improve the prognosis of cardiological patients. We present the case report of a patient who, in the past, had a pacemaker implanted due to symptomatic sick sinus syndrome (SSS) without removing the two remaining leads. Echocardiography revealed severe tricuspid valve regurgitation. The tricuspid valve septal cusp was in a restricting position due to the two ventricular leads passing through the valve. A few years later, she was diagnosed with breast cancer. We present a 65-year-old female admitted to the department due to right ventricular failure. The patient manifested symptoms of right heart failure, predominated by ascites and lower extremity edema, despite increasing doses of diuretics. The patient underwent a mastectomy two years ago due to breast cancer and was qualified for thorax radiotherapy. A new pacemaker system was implanted in the right subclavian area as the pacemaker generator occupied the radiotherapy field. In the case of right ventricular lead removal and the need for pacing and resynchronization therapy, guidelines allow a coronary sinus for LV pacing to avoid passing the leads through the tricuspid valve. We facilitated this approach in our patient, suggesting that the percentage of ventricular pacing was very low.