CTICasesHis Bundle Pacing Lead Placement
Imaging findings
Frontal and lateral chest radiographs demonstrate a dual-lead pacemaker where the atrial lead terminates in the right atrial appendage, and a second lead is positioned on the atrial side of the tricuspid valve annulus rather than the right ventricular apex. This distinct lead placement is confirmed on chest radiographs and fluoroscopy.
Key takeaways
His bundle pacing is an increasingly popular, more physiologic pacing modality that targets the native conduction system to prevent pacemaker-induced cardiomyopathy. Radiologists must recognize this specific lead position on the atrial side of the tricuspid annulus to avoid misinterpreting it as a displaced or malpositioned ventricular lead.
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