Computed tomography to assess possible cardiac lead perforation

Area of Science:

• Cardiovascular Imaging
• Medical Device Technology
• Radiology

Background:

• Standard methods like chest radiography and echocardiography are used for evaluating pacemaker and defibrillator lead migration.
• Computed tomography (CT) scanning can serve as a valuable adjunct in diagnosing lead migration.
• Assessing lead tip location is critical for device function and patient safety.

Observation:

• Chest CT was performed in three patients with suspected lead perforation where conventional imaging was inconclusive.
• Two patients underwent a specific cardiac CT protocol to assess lead tip position.
• In one case, a chest CT for pulmonary embolism incidentally revealed an extracardiac lead.

Findings:

• CT scans provided definitive diagnoses of extracardiac lead migration in all three cases.
• One patient had a dysfunctional but asymptomatic extracardiac atrial lead, managed conservatively.
• Two symptomatic patients with extracardiac ventricular leads and chest pain underwent successful lead revision.

Implications:

• CT imaging is essential for diagnosing lead perforation when other modalities are non-diagnostic.
• Advances in CT technology increase its utility in evaluating chest pain, necessitating assessment of intracardiac lead positions.
• Accurate lead placement and migration assessment are vital for optimal pacemaker and defibrillator function.