Magnetic resonance imaging in non-conditional pacemakers and implantable cardioverter-defibrillators: a systematic review and meta-analysis

AIMS: There is growing evidence that magnetic resonance imaging (MRI) scanning in patients with non-conditional cardiac implantable electronic devices (CIEDs) can be performed safely. Here, we aim to assess the safety of MRI in patients with non-conditional CIEDs. METHODS AND RESULTS: English scientific literature was searched using PubMed/Embase/CINAHL with keywords of 'magnetic resonance imaging', 'pacemaker', 'implantable defibrillator', and 'cardiac resynchronization therapy'. Studies assessing outcomes of adverse events or significant changes in CIED parameters after MRI scanning in patients with non-conditional CIEDs were included. References were excluded if the MRI conditionality of the CIEDs was undisclosed; number of patients enrolled was 0.5 V and impedance >50Ω was seen in 1.1% [95% confidence interval (CI) 0.7-1.8%] and 4.8% (95% CI 3.3-6.4%) respectively. The incidence of reduction in P- and R-wave sensing by >50% was 1.5% (95% CI 0.6-2.9%) and 0.4% (95% CI 0.06-1.1%), respectively. Battery voltage reduction of >0.04 V was reported in 2.2% (95% CI 0.2-6.1%). CONCLUSION: This meta-analysis affirms the safety of MR imaging in non-conditional CIEDs with no death or implantable cardioverter-defibrillator shocks and extremely low incidence of lead or device-related complications.Dian A. Munawar, Joel E.Z. Chan, Mehrdad Emami, Kadhim Kadhim, Kashif Khokhar, Catherine O’Shea ... et al

COVID-19 as a valuable learning opportunity: reflections from a public health placement at South Australia’s Department for Health and Wellbeing during the pandemic

Most medical students do not receive much public health exposure during their medical education, either in the form of theoretical teaching or practical placement experiences. At the University of Adelaide, students can elect to undertake a public health elective during winter school in addition to limited lectures with a public health focus, but there was not much opportunity for such placements prior to COVID-19. Following the interruption of clinical placements during the peak of the pandemic in South Australia, a modified academic structure saw the introduction of a twelve-week public health placement at the Department for Health and Wellbeing for final-year medical students. This article reflects on the author's immersive experience at the Department for Health and Wellbeing during the COVID-19 pandemic and includes a brief description of the department's services along with how it fits into the broader COVID-19 response. Public health placements can impact medical graduates' understanding and passion for health and society and their role as health advocates. Both of these are included in the Australian Medical Council's Graduate Outcomes statement. Public health placements are therefore worthwhile pursuing.Joel Ern Zher Cha