CTICasesSubcutaneous Defibrillation Lead for Inadequate Defibrillation Threshold
Imaging findings
Chest radiograph demonstrates standard LVAD and CRTD hardware with an additional subcutaneous lead along the left lower chest wall, separate from the transvenous endocardial lead system, placed to augment the defibrillation vector and achieve an adequate defibrillation threshold.
Key takeaways
Subcutaneous defibrillation leads (also called subcutaneous shocking leads or extravascular leads) may be placed in addition to a standard endocardial ICD lead when the defibrillation threshold is not met with the transvenous system alone. They may be positioned along the left chest wall, in the coronary sinus, or parasternally. Radiologists should recognize these as intentional, functional components of the ICD system and not mistake them for displaced or aberrant leads.
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