Pediatric Cardiac Pacemaker Lead Malfunction

  • Etiology: Placed in patients who require external pacing
  • Imaging: Correct position for cardiac pacemaker leads
    — Single chamber pacemaker: Lead terminates in the right ventricle
    — Dual chamber pacemaker: Leads terminate in the 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 the left ventricle
  • DDX:
  • Complications:
    — Pacemaker lead misplacement
    — Pacemaker lead dislodgement
    — Pacemaker lead fracture
  • Treatment: Replacement of pacemaker lead
  • Clinical:

Radiology Cases of Cardiac Pacemaker Lead Malfunction

Radiology Cases of Cardiac Pacemaker Lead Fracture

CXR of broken cardiac pacemaker leads
CXR AP (left) shows short lucent areas in the lateral aspect of the third and fourth pacemaker leads. Repeat CXR AP 1 month later (right) shows a complete discontinuity of the third pacemaker lead and elongation of the lucent area in the lateral aspect of the fourth pacemaker lead.
CXR of broken cardiac pacemaker lead.
CXR AP shows the cardiac pacemaker lead in the middle of the heart is not intact radiographically while the other two pacemaker leads are intact radiographically.