Chest X-ray: antero-posterior view

• right ventricular lead placed via the left cephalic vein with the generator in the pre-pectoral subcutaneous space
• lead terminal connector pin correctly engaged on the generator connector block
• the lead is directed inferiorly through the right atrium, curves through the tricuspid valve, and ends in a right ventricular anterior–inferior position with the tip at the apex
• no complication (no visible lead dislodgement, lead fracture, pneumothorax or perforation)

Comments

• chest X-ray is widely used in clinical practice for evaluation of lead location and integrity after device implantation and for diagnosis of complications and malfunction
• it is therefore crucial for radiologists to be familiar with the radiographic appearance of different types of devices and correct lead locations to be able to detect complications and abnormal lead position
• the manufacturer of the generator may sometimes be identified; this information can help physicians identify the manufacturer-specific programmer needed for testing

In order to assure a complete report when interpreting chest X-ray in an implanted patient, radiologists may go through the following checklist:

• device type (PM, CRT, ICD, S-ICD, loop recorder)
• connector pin insertion
• number and position of lead(s)
• lead(s) integrity
• complications (lead dislodgement, pneumothorax, perforation)