Radiography of cardiac conduction devices: a comprehensive review

Area of Science:

• Medical Imaging
• Cardiology
• Radiology

Background:

• Over 1 million patients in the US have permanent cardiac conduction devices (CCDs), including pacemakers and implantable cardioverter-defibrillators.
• Chest radiography is the sole imaging modality capable of assessing the physical integrity of CCD leads.
• A foundational understanding of CCD anatomy and the radiographic appearance of leads and generators is essential.

Purpose of the Study:

• To emphasize the critical role of radiologists in the assessment and follow-up of cardiac conduction devices.
• To highlight the importance of recognizing normal and abnormal radiographic findings associated with CCDs.
• To underscore the need for radiologists to possess a comprehensive understanding of CCD anatomy and potential complications.

Main Methods:

• Review of the unique capabilities of chest radiography in evaluating the physical integrity of CCD leads.
• Discussion of normal and abnormal radiographic appearances of CCDs and their components.
• Identification of acute and chronic complications associated with CCD implantation.

Main Results:

• Chest radiography uniquely evaluates the physical integrity of CCD leads.
• Acute complications include pneumothorax, perforation, and lead damage.
• Chronic complications involve lead displacement, fracture, and twiddler syndrome.

Conclusions:

• Radiologists play a pivotal role in the management of patients with CCDs, from implantation through long-term follow-up.
• A thorough understanding of CCDs, their evolving technology, and radiographic manifestations is crucial for effective patient care.
• Accurate interpretation of imaging is vital for identifying and managing device-related issues, ensuring optimal patient outcomes.