The implantable pace-maker-cardioverter-defibrillator: radiographic aspects

Safer and easier placement, recent approval by the U.S. Food and Drug Administration of several models, and increasing availability have expanded the use of implantable cardioverter-defibrillators (ICDs) for treatment of life-threatening ventricular tachyarrhythmia. Modern ICDs generally use a combination of two transvenously placed electrodes and one subcutaneous electrode; therefore, they do not require a thoracotomy for placement. The authors evaluated the radiographic aspects of one particular ICD--the pacemaker-cardioverter-defibrillator (PCD)--including the normal appearance and variations, confusing findings, and such complications as deformity of the subcutaneous patch electrode, lead fracture, and electrode malposition and migration. The PCD can also be combined with a preexisting, surgically placed automatic ICD or with a pacemaker. Familiarity with the PCD and other ICDs is essential, since the radiologist may be the first to recognize a complication that can render the device inoperative and leave the patient vulnerable to sudden death.