CTICasesCoronary Sinus Pacemaker Lead Migration
Imaging findings
Serial chest radiographs show a cardiac resynchronization therapy (CRT) device. The initial radiograph shows a left ventricular pacing lead successfully positioned posteriorly in the coronary sinus/cardiac vein. A follow-up radiograph demonstrates that the lead has migrated entirely back through the coronary sinus and right atrium, crossing the tricuspid valve to rest anteriorly in the right ventricle. No change in the generator pocket or lead wrapping is seen.
Key takeaways
Left ventricular pacing leads placed in the coronary sinus can migrate over time, often facilitated by cardiac pulsations or inadequate anchoring, and can travel back along the path of venous blood flow into the right atrium and ventricle. Radiologists should compare current pacing lead positions with historical films to quickly identify migration, which results in a loss of cardiac resynchronization therapy benefits.
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