Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia. Electronic address: http://www.twitter.com/pitmabm.
Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
Heart Lung Circ. 2023 Feb;32(2):252-260. doi: 10.1016/j.hlc.2022.10.005. Epub 2022 Nov 25.
Most modern cardiac implantable electronic device (CIED) systems are now compatible with magnetic resonance imaging (MRI) scans. The requirement for both pre- and post-MRI CIED checks imposes significant workload to the cardiac electrophysiology service. Here, we sought to determine the burden of CIED checks associated with MRI scans.
We identified all CIED checks performed peri-MRI scans at our institution over a 3-year period between 1 July 2017 to 30 June 2020, comprising three separate financial years (FY). Device check reports, MRI scan reports and clinical summaries were collated. The workload burden was determined by assessing the occasions and duration of service. Analysis was performed to determine cost burden/projections for this service and identify factors contributing to the workload.
A total of 739 CIED checks were performed in the peri-MRI scan setting (370 pre- and 369 post-MRI scan), including 5% (n=39) that were performed outside of routine hours (weekday <8 am or >5 pm, and weekends). MRIs were performed for 295 patients (75±13 years old, 64% male) with a CIED (88% permanent pacemaker, and 12% high voltage device), including 49 who had more than one MRI scan. The proportion of total MRI scans for patients with a CIED in-situ increased each FY (from 0.5% of all MRIs in FY1, to 0.9% in FY2, to 1.0% in FY3). The weekly workload increased (R=0.2, p<0.001), but with week-to-week variability due to ad hoc scheduling (209 days with only one MRI vs 78 days with ≥2 MRIs for CIED patients). The projected annual cost of this service will increase to AUD$161,695 in 10 years for an estimated annual 546 MRI scans for CIED patients.
There is an increasing workload burden and expense associated with CIED checks in the peri-MRI setting. Appropriate budgeting, staff allocation and standardisation of automated CIED pre-programming features among manufacturers are urgently needed.
现在，大多数现代心脏植入式电子设备（CIED）系统都与磁共振成像（MRI）兼容。在 MRI 前后都需要对 CIED 进行检查，这给心脏电生理服务带来了巨大的工作量。在这里，我们旨在确定与 MRI 检查相关的 CIED 检查负担。
我们在 2017 年 7 月 1 日至 2020 年 6 月 30 日的 3 年期间，确定了我们机构内所有在 MRI 扫描期间进行的 CIED 检查，包括三个单独的财政年度（FY）。我们收集了设备检查报告、MRI 扫描报告和临床总结。通过评估服务的次数和持续时间来确定工作量负担。分析了该服务的成本负担/预测，并确定了导致工作量增加的因素。
在 MRI 扫描期间共进行了 739 次 CIED 检查（370 次 MRI 前检查和 369 次 MRI 后检查），其中 5%（n=39）是在非工作时间（周一至周五<8 点或>5 点，以及周末）进行的。共对 295 名（75±13 岁，64%为男性）有 CIED（88%为永久性起搏器，12%为高压设备）的患者进行了 MRI 检查，其中 49 名患者进行了多次 MRI 检查。在 FY1 中，具有原位 CIED 的患者的 MRI 扫描比例占所有 MRI 扫描的 0.5%，FY2 中占 0.9%，FY3 中占 1.0%。每周的工作量增加（R=0.2，p<0.001），但由于临时安排，每周的工作量存在差异（CIED 患者每周有 1 次 MRI 的天数为 209 天，有≥2 次 MRI 的天数为 78 天）。预计该服务的年度成本将在 10 年内增加到 161695 澳元，估计每年有 546 次 CIED 患者的 MRI 检查。
在 MRI 前后进行 CIED 检查会带来越来越大的工作量负担和费用。迫切需要在制造商之间进行适当的预算编制、人员配置和自动化 CIED 预编程功能的标准化。
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