Nurse practitioner-led CIED monitoring during MRI in pediatric and adult patients with congenital heart disease.

BACKGROUND: Recent evidence shows minimal risk to patients undergoing magnetic resonance imaging (MRI) with cardiac implantable electronic devices (CIEDs), even those with MRI non-conditional devices or epicardial and/or abandoned leads. OBJECTIVE: We report our experience with peri-MRI device care for pediatric and adult patients with congenital heart disease (CHD) provided by pediatric electrophysiology (EP) nurse practitioner(s) (NP). METHODS: Retrospective study of pediatric and adult patients with CHD with CIEDs undergoing MRI between November 2022 and February 2025. An International Board of Heart Rhythm Examiners device certified NP led the service, determined CIED MRI compatibility and risk, determined programming for scan and provided patient rhythm monitoring for non-conditional devices. EP NPs provided pre and post-MRI evaluation and programming conditional devices. Full interrogation was completed prior and immediately after MRI. RESULTS: There were 28 patients who underwent MRI with CIED; median age 21.7 (interquartile range [IQR] 18-23; range 0.5-37) years. Epicardial pacemakers (PM) in 15 (53%), transvenous PM or ICD in 11 (40%), and S-ICD in 2 (7%). 7 patients (25%) had abandoned leads. 18 CIEDs (65%) were MRI non-conditional. No patient had clinically significant change in lead parameters, concerning arrhythmia or patient reported symptoms during MRI scan. The median NP time provided in MRI for a patient requiring continuous monitoring, n = 22 (79%), was 100 minutes (IQR 80-129). CONCLUSION: EP NP provided peri-MRI device management can be a successful and physician adjacent service. There were no adverse outcomes including lead measurement changes, patient reported symptoms or arrhythmia for patients which was consistent with prior studies. Time spent in MRI does not include time for preliminary assessment and determination of risk.