Imaging and right ventricular pacing lead position: a comparison of CT, MRI, and echocardiography

Moore, Peter, Coucher, John, Ngai, Stanley, Stanton, Tony, Wahi, Sudhir, Gould, Paul, Booth, Cameron, Pratap, Jit and Kaye, Gerald (2016) Imaging and right ventricular pacing lead position: a comparison of CT, MRI, and echocardiography. PACE - Pacing and Clinical Electrophysiology, 39 4: 382-392. doi:10.1111/pace.12817

Author Moore, Peter
Coucher, John
Ngai, Stanley
Stanton, Tony
Wahi, Sudhir
Gould, Paul
Booth, Cameron
Pratap, Jit
Kaye, Gerald
Title Imaging and right ventricular pacing lead position: a comparison of CT, MRI, and echocardiography
Journal name PACE - Pacing and Clinical Electrophysiology   Check publisher's open access policy
ISSN 1540-8159
Publication date 2016-04
Year available 2016
Sub-type Article (original research)
DOI 10.1111/pace.12817
Open Access Status Not Open Access
Volume 39
Issue 4
Start page 382
End page 392
Total pages 11
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2017
Language eng
Formatted abstract
Background: Right ventricular nonapical (RVNA) pacing may reduce the risk of heart failure. Fluoroscopy is the standard approach to determine lead tip position, but is inaccurate. We compared cardiac computed tomography (CT), magnetic resonance imaging (MRI), two-dimensional and three-dimensional transthoracic echocardiography (TTE), and chest x-ray (CXR) to assess which provides the optimal assessment of right ventricular (RV) lead tip position.

Methods: Eighteen patients with MRI-conditional pacemakers (10 RVNA and eight apical [RVA] leads) underwent contrast CT, MRI, TTE, and a standard postimplant posteroanterior and lateral CXR. To compare images, the RV was arbitrarily partitioned into three long-axis segments (right ventricular outflow tract, middle, and apex), and two short-axis segments (septal and nonseptal). Agreement between modalities was assessed.

Results: RV lead tip position was identified in all patients on CT, TTE, and CXR, but was not identified in seven (39%) patients on MRI due to device-related artifact. Of 10 leads deemed to be nonapical/septal during implant, 70% were identified as nonapical on CXR, 60% on CT, 60% on MRI, and 80% on TTE. On CT imaging only 10% were truly septal, 20% on MRI, 30% on CXR, and 80% on TTE. Agreement was better between modalities when assessing position of the designated RVA leads.

Conclusion: During implant leads intended for the septum are not confirmed as such on subsequent imaging, and marked heterogeneity is apparent between modalities. MRI is limited by artifact, and discrepancy exists between TTE and CT in identifying septal lead position. CT gave the clearest definition of lead tip position.
Keyword Echocardiography
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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