- 73-year-old woman
- syncope and complete atrio-ventricular block
- dual-chamber pacemaker
- chest X-ray 1 day after implantation
Chest X-ray: antero-posterior view
- right atrial lead dislodged into the superior vena cava
Now let’s look at some other X-rays.
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- pacemaker leads are either equipped with tines (passive fixation) or with a screw (active fixation); both types of electrodes provide similar results in a long-term follow-up and the use of one or the other electrode type is mainly based on the implanter´s preference
- active fixation is accomplished by means of a screw tip, which can be visible on chest X-ray
- passive fixation leads are caught in the trabeculae lining the atrium or ventricle
- chest radiography is the preferred imaging modality to evaluate leads location, lead wire integrity and help in identifying several complications
- lead dislodgements have been classified as “macrodislodgement” versus “micro-dislodgement”, early versus late dislodgement
- macrodislodgement is radiographically evident whereas microdislodgement is not (harder to detect)
- early dislodgements occur within the first six weeks after implantation, and late dislodgements, after this period of time
- early dislodgements are much more frequent than late dislodgements and affect more frequently atrial leads
- Review / Skip