Inter-vendor Variability of Pacemaker Susceptibility Artifact at 1.5 T: Extent and Clinical Impact

Background: Cardiovascular magenetic resonance (CMR) studies involving cardiac implantable electronic devices (CIEDS) are increasing, yet comparative reports on susceptibility artifact are lacking. Such data could inform decision making both at the time of implantation as well as at the time of imaging. We compared the extent and clinical impact of susceptibility artifact across 3 pacemaker (PPM) vendors during CMR.

Methods: Thirty patients (10 per vendor) with pre-pectoral PPM and endocardial pacing leads who underwent CMR on a single 1.5T system (Siemens Sola) between 2019-2025 were evaluated retrospectively. Defibrillators as well as leadless PPM were excluded. PPM dimensions were determined from vendor data, including Boston Scientific (PPM-BS), Medtronic(PPM-M) and Abbott (PPM-A). Anonymized studies were randomly assigned into 2 groups. A radiologist and a cardiologist independently assessed artifact size and subjective interpretability. Artifact extent (arc diameter) was measured for several acquisitions: 4-chamber cine, 2-chamber cine, short-axis cine, and axial SSFP planes as well as phase-sensitive inversion recovery (PSIR) single-shot late gadolinium enhancement (LGE) in the short-axis plane. Qualitative assessment classified each image for interpretability: completely, partially, or not interpretable. For analysis, Kruskal Wallis test was employed for continuous variables and Fischer's exact test was used for categorical variables. Bonferroni correction adjusted for multiple comparisons post-hoc.

Results: On axial SSFP images, there was a significant difference in artifact size among the three vendors: 15.2 ± 1.4 cm with PPM-BS, 14.9 ± 1.9 cm with PPM-A, and 8.8 cm ± 1.9 cm with PPM-M (P< 0.001). Published PPM dimensions were similar. Post-hoc comparisions showed PPM-M associated with smaller artifact size when compared to both PPM-BS (P< 0.001) and PPM-A (P=0.001). There were also significant differences in artifact size on short-axis cine (P=0.015) and LGE images (P=0.007). On post-hoc analysis, PPM-M demonstrated smaller artifact size as compared to PPM-BS on short-axis cine (P=0.03) and LGE (P=0.006). There was no difference between PPM-M and PPM-A. For subjective interpretability, PPM-M was more often interpretable on 2-chamber cine and short-axis cine. Additionally, on 2-chamber cine, all images with PPM-M 10/10 were completely interpretable as compared with PPM-BS 3/10; P=0.009).

Conclusion: As compared with PPM-BS and PPM-A, similarly sized PPM-M devices demonstrated less susceptibility artifact and greater interpretability. Knowledge of differences in artifact trends by vendor may be useful at several points in the patient care journey: choice of device at the time of implantation, decision making regarding potential referral (or not) for CMR study, as well as in imaging protocol (pulse sequence) specification at CMR. Further investigation across a larger cohort as well as phantom studies are warranted.

Summary of artifact characteristics as well as chest radiograph and corresponding CMR SSFP image representative for each PPM vendor