Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 251--252

Pacemaker lead design masquerading as lead fracture


Madhu Gangadhara1, Charles Peebles2, James Gnanapragasam1,  
1 Department of Paediatric Cardiology, University Hospital Southampton NHS Trust, Southampton, UK
2 Department of Radiology, University Hospital Southampton NHS Trust, Southampton, UK

Correspondence Address:
Madhu Gangadhara
D level office, Department of Paediatric Cardiology, University Hospital Southampton NHS Trust, Tremona road, Southampton, SO16 6YD
UK

Abstract

Performing chest X-ray is an important annual investigation to check pacemaker lead integrity during follow-up of patients with pacemakers. Understanding lead design is vital to the correct interpretation of X-rays to prevent inappropriate interventions for patients as highlighted in this case.



How to cite this article:
Gangadhara M, Peebles C, Gnanapragasam J. Pacemaker lead design masquerading as lead fracture.Ann Pediatr Card 2015;8:251-252


How to cite this URL:
Gangadhara M, Peebles C, Gnanapragasam J. Pacemaker lead design masquerading as lead fracture. Ann Pediatr Card [serial online] 2015 [cited 2021 Dec 1 ];8:251-252
Available from: https://www.annalspc.com/text.asp?2015/8/3/251/158521


Full Text

 CLINICAL SUMMARY



A 5-year-old girl with a permanent epicardial pacemaker implanted at 6 months of age for complete heart block following Tetralogy of Fallot repair, attended her annual pacemaker check.

She had a Medtronic Adapta epicardial pacemaker with unipolar atrial and bipolar ventricular leads. She was asymptomatic and her pacemaker check showed no abnormalities.

Chest X-ray [Figure 1] was initially reported as showing a lead fracture in one arm of her bipolar ventricular lead [[Figure 2], black arrow]. However, further review of the chest X-ray with an understanding of this bipolar lead design [[Figure 3], white arrow] enabled correction of this error in interpretation.{Figure 1}{Figure 2}{Figure 3}

 DISCUSSION



The connection between the two limbs of the bipolar lead consists of a short segment which is at right angles to the two limbs, and this area can appear relatively radiolucent mimicking a lead fracture.

Understanding the variations of pacemaker lead design is vital to avoid misinterpretation of chest X-rays when screening for lead integrity and can prevent inappropriate action. [1],[2]

References

1Ellenbogen KA, Hellkamp AS, Wilkoff BL, Camunãs JL, Love JC, Hadjis TA, et al. Complications arising after implantation of DDD pacemakers: The MOST experience. Am J Cardiol 2003;92:740-1.
2Udo EO, Zuithoff NP, van Hemel NM, de Cock CC, Hendriks T, Doevendans PA, et al. Incidence and predictors of short-and long-term complications in pacemaker therapy: The FOLLOWPACE study. Heart Rhythm 2012;9:728-35.