# Safe and Effective MRI for Pediatric Patients with a Cardiac Implantable Electronic Device

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2024 · $702,731

## Abstract

Abstract: A substantial number of infants and children with congenital heart defects (CHD), inherited arrhythmia
syndromes, and/or congenital disorders of cardiac conduction require a cardiac implantable electronic device
(CIED). The current approach to affixing a CIED lead to the heart of a young patient is to open the chest and
sew the lead directly to the epicardium (“epicardial leads”), whereas the approach in older adolescents and adults
is passing it through veins and affixing to the endocardium (“endocardial leads”). Once epicardial leads are
implanted, however, the patient is no longer eligible for routine magnetic resonance imaging (MRI) due to the
increased risk of radiofrequency (RF)-induced heating of myocardial tissue. The problem is exacerbated by the
fact that there is no straightforward method to extract leads, so children who receive such leads are excluded
from the benefits of MRI even if a subsequent FDA-approved endocardial CIED system replaces an epicardial
system when they are older. Such patients are often referred for alternative imaging modalities with ionizing
radiation, which may result in suboptimal care and a significant radiation risk for children. Our strong, preliminary
data show that CHD patients with a CIED have four-fold higher cumulative effective doses of radiation from
computed tomography and X-ray than matched pediatric CHD patients with no CIED, thereby highlighting an
urgent need to increase access to MRI for pediatric CIED patients. The 2017 HRS consensus statement is blunt
in emphasizing the need for more research: “Given the paucity of data related to the safety of MRI [with epicardial
leads], recommendations cannot be made [and] many questions remain unanswered.” Even if MRI safety issues
are resolved through engineering, the diagnostic yield of cardiac MRI remains low due to severe image artifact
caused by the Implantable Pulse Generator (IPG). Existing “wideband” pulse sequences developed for adults
are unsuitable for pediatric CIED patients due to two main reasons: (a) the proximity of IPG to the heart is closer
in pediatric patients than adults, necessitating a wider bandwidth RF pulse design; (b) pediatric patients have
smaller hearts and faster heart rates than adults, necessitating higher data acquisition acceleration. In direct
response to this unmet clinical need, this study seeks to develop innovative technologies to achieve the following
three objectives: (1) determine imaging conditions under which MRI can be performed safely in children,
regardless of CIED types and abandoned leads; (2) develop, implement, and validate physics-based epicardial
lead implantation strategies that minimize the variation and magnitude of RF heating in pediatric patients with a
CIED; (3) develop and validate age-specific, free-breathing, wideband cardiovascular MRI pulse sequences that
produce diagnostically acceptable image quality in pediatric CIED patients. If successful, our work will extend
MRI access to a ...

## Key facts

- **NIH application ID:** 10805223
- **Project number:** 1R01HL168859-01A1
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Laleh Golestani Rad
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $702,731
- **Award type:** 1
- **Project period:** 2024-03-01 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10805223

## Citation

> US National Institutes of Health, RePORTER application 10805223, Safe and Effective MRI for Pediatric Patients with a Cardiac Implantable Electronic Device (1R01HL168859-01A1). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10805223. Licensed CC0.

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