Recommendations of the German Cardiac Society on CMR examinations in patients with cardiac pacemakers and implantable cardioverter defibrillators. From the Committee for Clinical Cardiovascular Medicine

Cardiovascular magnetic resonance (CMR) imaging examinations can nowadays be safely performed in patients with both magnetic resonance imaging (MRI)-conditional cardiac implantable electronic devices (CIED) as well as in those with non-MRI tested (older) CIEDs, if the prerequisites illustrated in this recommendation article of the German Cardiac Society (DGK) are exactly followed. In principle, CMR examinations in CIED patients should be performed in experienced CMR centers with appropriate personnel and technical resources. In addition to cardiological expertise in the treatment of CIED patients and in programming of CIEDs, additional experiences in performing CMR examinations and using appropriate CMR imaging protocols depending on the individual patient profile and CIED type are required. An individual and careful assessment of the risk-benefit ratio plays a decisive role in CIED patients. In this context, important aspects such as the potential off-label use of CMR in patients with non-MRI tested CIEDs or the use of new CMR protocols should be adequately considered. At the same time it should also be considered that those CIED patients with particularly challenging individual constellations could clinically benefit the most from a safe and successfully carried out CMR examination. Regarding the assessment of the individual risk-benefit ratio, it is necessary not only to make a precise estimation of the individual patient risk associated with the CIED but also the probability of acquiring high-quality CMR images that are helpful for making clinical decisions. Hence, the knowledge and availability of the specific CMR protocols that are addressed in the present recommendations of the DGK are highly important for adequate assessment of the individual risk-benefit ratio in CIED patients.