Differential diagnosis of pediatric cardiac pacemaker lead malfunction

• Pacemaker lead misplacement
• Pacemaker lead dislodgement
• Pacemaker lead fracture

Approach to the differential diagnosis of cardiac pacemaker lead malfunction:

• Use CXR to ensure pacemaker leads are intact
• Use CXR to ensure pacemaker leads are in correct position
  — Single chamber pacemaker – lead terminates in right ventricle
  — Dual chamber pacemaker – leads terminate in right atrial appendage and right ventricular apex
  — Biventricular pacemaker – normal dual chamber pacemaker with additional lead that is introduced along coronary sinus and wedged in left ventricular cardiac vein overlying left ventricle