Most major hospitals and many large outpatient imaging centers now perform MRI scans on patients with pacemakers, though the process requires extra steps that not every facility is set up to handle. Whether you can get one, and where, depends largely on what type of pacemaker you have and what equipment and staff the facility can provide.
Your Pacemaker Type Matters Most
Pacemakers fall into two categories when it comes to MRI compatibility. Devices implanted roughly since 2011 are often labeled “MRI-conditional,” meaning they were specifically designed and FDA-approved for use in an MRI environment. Older devices, sometimes called “legacy” pacemakers, were not designed with MRI in mind and carry additional considerations.
MRI-conditional pacemakers use nonmagnetic materials, redesigned lead wiring that resists heating, and a Hall sensor instead of the older reed switch found in legacy devices. The reed switch in older pacemakers behaves unpredictably inside a magnetic field, while the Hall sensor responds in a controlled, consistent way. These design changes make the newer devices far more straightforward to scan. However, the “MRI-conditional” label only applies when the entire system is compatible: the generator and every lead must be MRI-conditional. If an MRI-conditional generator was connected to older conventional leads, the system is not considered safe under standard MRI-conditional protocols.
If you’re unsure which type you have, your cardiologist’s office can pull up your device records. Your pacemaker ID card, which you should have received after implantation, also lists the manufacturer and model number.
Where to Look for an MRI-Capable Facility
For MRI-conditional pacemakers, the range of facilities is broad. Many hospital-based radiology departments and larger freestanding imaging centers routinely scan patients with these newer devices. The key requirements are a 1.5 Tesla MRI machine (the most common clinical strength), staff trained in device management, and the ability to reprogram your pacemaker before and after the scan. Some facilities handle all of this in-house, while others coordinate with your cardiologist’s office to have the device reprogrammed the same day.
For legacy (non-MRI-conditional) pacemakers, your options narrow considerably. These scans typically happen at academic medical centers or large hospital systems with dedicated cardiac device teams. The facility needs personnel who can manage the device during the scan, continuous cardiac monitoring equipment rated for use inside the MRI suite, and protocols for handling complications if they arise. Smaller outpatient imaging centers rarely have this infrastructure.
Your best starting points are:
- Your cardiologist’s office. They know your device, can confirm its MRI status, and typically have referral relationships with imaging centers experienced in scanning pacemaker patients.
- University or academic hospital radiology departments. These centers scan the highest volume of pacemaker patients and are most likely to accept legacy devices.
- Your pacemaker manufacturer’s website. Medtronic, Abbott, Boston Scientific, and Biotronik all maintain online tools or phone lines to help locate MRI-capable facilities for their devices.
What Happens Before the Scan
Getting an MRI with a pacemaker involves more preparation than a standard scan. Before you’re placed in the machine, a trained professional reprograms your device into a specific MRI-safe mode. For patients who don’t depend on their pacemaker for every heartbeat, this usually means turning pacing off entirely so the device only monitors your heart rhythm. For pacemaker-dependent patients, the device is switched to an asynchronous pacing mode, which delivers steady pacing pulses at a fixed rate regardless of what the heart is doing on its own. Defibrillator functions, if present, are turned off to prevent the magnetic field from triggering an inappropriate shock.
This reprogramming typically takes just a few minutes and is done with a handheld programmer placed over your chest. It must be performed by someone trained in cardiac device management, which is one reason not every imaging center can accommodate pacemaker patients.
Monitoring During the Scan
Throughout the MRI, you’ll be monitored more closely than a typical patient. The American College of Cardiology recommends MRI-compatible pulse oximetry, continuous heart rhythm monitoring, and blood pressure checks for the duration of the scan. A team member watches these readings in real time, ready to stop the scan and pull you out if anything looks abnormal. This is standard practice at facilities that regularly scan pacemaker patients, and it’s one of the reasons these scans take a bit longer to schedule and perform than routine MRIs.
What Happens After the Scan
Once the MRI is complete, your pacemaker is reprogrammed back to its original settings. The device is also “interrogated,” a quick diagnostic check that reads out key measurements: how well the leads are sensing your heart’s electrical signals, how much energy is needed to pace your heart, and whether the battery or lead performance changed during the scan. This entire process usually takes 10 to 15 minutes and happens right in the MRI suite or a nearby room.
How Safe Is It With a Legacy Device?
A landmark study published in the New England Journal of Medicine tracked over 1,500 patients with legacy (non-MRI-conditional) pacemakers and defibrillators across more than 2,100 MRI scans. No long-term clinically significant adverse events occurred. The most notable issue was the device resetting to a backup mode, which happened in about 1 in 200 scans. Of those nine resets, eight were temporary and resolved on their own. One occurred in a device already near the end of its battery life and required replacement. Small changes in lead performance were detected in some patients at follow-up (around 4% saw shifts in sensing or pacing thresholds), but none required reprogramming or device revision.
The study used a strict safety protocol at every scan, which is why facility selection matters. The risks are manageable, but they require the right team and monitoring setup. Patients with abandoned or broken leads face additional uncertainty because the heating behavior of a disconnected lead fragment inside a magnetic field is harder to predict.
Insurance and Medicare Coverage
For MRI-conditional pacemakers used according to FDA-approved labeling, Medicare has covered MRI scans since 2011. For legacy devices, Medicare coverage is available when the scan is performed as part of an approved clinical study, a framework called “Coverage with Study Participation.” Many large academic centers participate in these studies, which is another reason they’re often the best option for legacy device patients.
Private insurers generally follow Medicare’s lead, but prior authorization is almost always required. Your ordering physician will need to document the medical necessity of the MRI, and the imaging facility will typically need to confirm they have the appropriate protocols in place. Expect this approval process to add a few days to a couple of weeks to your scheduling timeline. Having your cardiologist’s office coordinate directly with the imaging center speeds things up considerably, since both parties need to share device information and scheduling availability for the reprogramming steps.