Standard X-ray is inadequate for the identification of conductor cable externalization in riata leads

摘要

A 78-year-old man with a long history of congestive heart failure due to ischemic cardiomyopathy had undergone placement of a biventricular pacemaker and defibrillator (Atlas HF V-341, St. Jude Medical, MN, USA) 5 years before. An active silicone-coated St. Jude Medical Riata ST lead (model 7000/65 cm) was placed in the right ventricular apex, an active fixation atrial lead (St. Jude Medical 1688T/52 cm) was placed in the right atrium, and a bipolar lead (St. Jude Medical QuickSite 1056 T) was placed in the coronary sinus. All pacing and sensing parameters as well as high-voltage impedance were stable and optimal during routine periodic follow-up visits in the outpatient clinic. Due to the recently reported high prevalence of insulation failure with externalized conductors in Riata family leads, we reviewed a chest radiography performed a year before where no evidence for externalized lead was evident (Fig. 1, panels A and B, lateral view). Additional biplane (posteroanterior and lateral view) chest radiographs were performed in the last visit previous to a scheduled defibrillator battery replacement. The lateral view clearly demonstrated cable extrusion located proximal to the distal coil (Fig. 1, panels C and D, black arrow) not visible in the posteroanterior view. In view of the abnormal image, a second X-ray was performed in order to confirm the findings by the radiologist (Fig. 1, panels E and F, lateral view). Cable extrusion was not observed in the second radiography.