MRI Scan Early after Implantation of an MRI Conditional Implantable Cardioverter-Defibrillator: Case Report

Abstract

Introduction: MRI scans are not recommended for the first four weeks after device implantation. However, conditions like hypoxic-ischaemic encephalopathy can only be evaluated by MRI. A case where MRI brain was done in a patient with HIE four days after ICD implantation has been reported. Case History: A 54 year old male with old anterior wall myocardial infarction presented with recurrent monomorphic, pulseless ventricular tachycardia. Anti-arrhythmic treatment resulted in severe junctional bradycardia for which temporary pacemaker was inserted. After 48 hours of stability, Medtronic Evera MRI XT DR SureScanTM Series DDMB2D1 implantable cardiovertor-defibrillator was implanted. During implantation, patient had ventricular fibrillation requiring prolonged (Comprehensive Cardiac Rehabilitation) CCR for 45 minutes. Post-procedure, he remained comatose for more than 48 hours. Bedside EEG showed mild to moderate generalised encephalopathy which did not match the clinical picture. Therefore, MRI brain was done on fourth day after implant taking risk consent from the patient’s wife. The MRI scan was done safely using SureScan mode. It showed mild changes of hypoxic encephalopathy suggesting a decent prognosis. The ICD lead positions and parameters were rechecked and found to be optimum. The patient slowly recovered over three weeks. He needed dialysis for acute kidney injury, antibiotics for ventilator associated pneumonia, tracheostomy for ventilation and percutaneous endoscopic gastrostomy for feeding. He was discharged with percutaneous endoscopic gastrostomy (PEG) in-situ and improving neurological status. Conclusion: While a single case cannot make a recommendation, this case demonstrates that it not impossible to do an MRI scan safely in a patient very shortly after an ICD implant if the clinical situation warrants it.