Off-Label MRI in 2017 of CIEDs: A Daily "Fork-in-the Road" for Implanters and the Case for Common Sense.

Both non-MRI conditional and MRI conditional systems are widely available. 25 Physicians must choose which type of device to place. While off-label MRI can often be done safely, significant administrative and financial burdens remain to the physician posing a significant dilemma as to which device to choose. These issues are reviewed in a detailed direct manner. Off-Label MRI in 2017 of CIEDs: A Daily “Fork-in-the Road” 30 for Implanters and the Case for Common Sense. In this issue of PACE, Emory University report their experience of both magnetic resonance imaging (MRI) of non-MRI conditional devices (often called, “legacy devices” or “off-label MRI”) and MRI conditional devices. (1) 35 Using the metric that any difference in outcomes of off and on label MRI only be considered relevant if “clinically actionable”, Shah, et al. conclude “the findings presented may suggest equivalent low clinical risk when MR imaging is performed in patients with MRI conditional and non-MR conditional devices, under the specific protocol utilized”. (1) In their series of 96 off-label scans, 40 small non-significant lead parameter changes did not require lead revision or programming changes and no device reset, or device failures were observed.