Chest radiographs are valuable in demonstrating clinically significant pacemaker complications that require reoperation

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Abstract

Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation. Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37-96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test. Results: Of the patients, 1.7% (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57% of patients (8/14) at a median of 2 days (<1-32 days) after implantation and in 5% of the controls (2/42) (P <.0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls (P =.0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls (P =.25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls (P =.06). Conclusions: Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.

Original languageEnglish (US)
Pages (from-to)288-295
Number of pages8
JournalCanadian Association of Radiologists Journal
Volume62
Issue number4
DOIs
StatePublished - Nov 2011

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Reoperation
Thorax
Electric Impedance
Radiography
Equipment and Supplies

Keywords

  • Chest radiography
  • Complications
  • Pacemaker

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{e16a4af159b74accb4e48742bfdd2d88,
title = "Chest radiographs are valuable in demonstrating clinically significant pacemaker complications that require reoperation",
abstract = "Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation. Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37-96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test. Results: Of the patients, 1.7{\%} (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57{\%} of patients (8/14) at a median of 2 days (<1-32 days) after implantation and in 5{\%} of the controls (2/42) (P <.0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls (P =.0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls (P =.25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls (P =.06). Conclusions: Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.",
keywords = "Chest radiography, Complications, Pacemaker",
author = "Diane Belvin and Hirschl, {David A.} and Jain, {Vineet R.} and Alla Godelman and Stein, {Marjorie W.} and Gross, {Jay N.} and Haramati, {Linda B.}",
year = "2011",
month = "11",
doi = "10.1016/j.carj.2010.04.016",
language = "English (US)",
volume = "62",
pages = "288--295",
journal = "Canadian Association of Radiologists Journal",
issn = "0846-5371",
publisher = "Canadian Medical Association",
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T1 - Chest radiographs are valuable in demonstrating clinically significant pacemaker complications that require reoperation

AU - Belvin, Diane

AU - Hirschl, David A.

AU - Jain, Vineet R.

AU - Godelman, Alla

AU - Stein, Marjorie W.

AU - Gross, Jay N.

AU - Haramati, Linda B.

PY - 2011/11

Y1 - 2011/11

N2 - Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation. Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37-96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test. Results: Of the patients, 1.7% (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57% of patients (8/14) at a median of 2 days (<1-32 days) after implantation and in 5% of the controls (2/42) (P <.0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls (P =.0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls (P =.25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls (P =.06). Conclusions: Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.

AB - Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation. Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37-96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test. Results: Of the patients, 1.7% (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57% of patients (8/14) at a median of 2 days (<1-32 days) after implantation and in 5% of the controls (2/42) (P <.0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls (P =.0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls (P =.25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls (P =.06). Conclusions: Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.

KW - Chest radiography

KW - Complications

KW - Pacemaker

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