Dispositivos cardíacos eletrônicos implantáveis em radiologia: uma revisão sistemática em ressonância magnética e radioterapia

Abstract

Implantable cardiac electronic devices (CIEDs), such as pacemakers, implantable cardioverterdefibrillators, and cardiac resynchronization therapy devices, are essential in the treatment of rhythm and conduction disorders. However, their presence imposes significant restrictions on procedures such as magnetic resonance imaging (MRI) and oncological therapies like radiotherapy (RT), due to the potential for interference with electromagnetic fields and exposure to ionizing radiation. Despite technological advances that have enabled the development of devices compatible with these technologies, there is still misinformation in clinical practice and uncertainty regarding the safety of these procedures. Therefore, this study aimed to synthesize and analyze recent research discussing the possible interactions between CIEDs and MRI/RT, the main risks and reported adverse events, and current protocols and clinical guidelines for the management of these patients. The research method consisted of a literature review conducted through the PubMed and ScienceDirect databases, applying specific selection criteria for articles published between 2020 and 2025. Studies that directly addressed the interaction between CIEDs and the procedures in question were included, along with key clinical consensus documents, while case reports, exclusively in vitro studies, and publications with very small sample sizes were excluded. After screening and full-text review, 14 main articles were selected, eight addressing MRI and six RT. As a result, it was found that although the physical mechanisms of interference differ between MRI and RT, the reported device malfunctions showed similarities, with a predominance of technical events such as software resets, changes in sensitivity and pacing parameters, and battery depletion. In both techniques, the rate of significant clinical and technical events was low. Risk factors varied according to the modality: in MRI, device conditionality, the presence of abandoned leads, and pacing dependency were predominant; in RT, beam energy and the location of the irradiated field, particularly when close to the device, were the most relevant. The reviewed guidelines provided clear recommendations for safe procedure management, including measures such as preprocedure reprogramming, monitoring during the exam, and periodic device interrogations. It is concluded that both MRI and RT can be safely performed in patients with CIEDs, provided that specific protocols are followed and there is coordinated action by a multidisciplinary team. Finally, the study highlights the importance of continuously updating institutional protocols and disseminating clinical guidelines across healthcare centers of different levels of complexity, as a means of ensuring safe access and improving the quality of care for this population.