Slide 1: What common lead complication occurred in this patient? Soon after placement. 1 year later.

Slide 2: What common lead complication occurred in this patient? Soon after placement. 1 year later. Notice that the ICD lead has backed out of its original position. There has been interval twisting of the proximal leads, likely from the patient manipulating the battery pack in its pocket underneath the skin. This is called “twiddler’s syndrome.”

Slide 3: What happened to this malfunctioning pacemaker?

Slide 4: What happened to this malfunctioning pacemaker? One of the leads has fractured. This often occurs at areas of external pressure, such as here, between the clavicle and the first rib!

Slide 5: Let’s summarize our 2 pacer bytes. If the patient has an implantable cardiac device on CXR, ask…

1. Is it an ICD? Look for thick coils of defibrillator leads.

2. What device type? Look for lead number and position. Apps can identify the manufacturer.

3. Complication? Look for lead fracture, perforation or malposition.

For more about pacemakers listen to the CoreIM podcast on your podcast player of choice! And look out for a 12-lead Thursday byte to review pacemakers and ECG.