CTICasesExternalization of Pacemaker Lead (Medtronic Riata Lead)
Imaging findings
On chest radiograph, a subtle displacement of the conducting electrode away from the right ventricular lead is observed, indicating externalization. Cine fluoroscopy during the procedure provided better visualization of this displacement. A photograph of the extracted lead clearly shows the blue conductor completely outside its insulation. Externalization of a coronary vein lead was also subtly suggested.
Key takeaways
Externalization is a notorious mode of failure for certain pacemaker leads, specifically the Medtronic Riata and St. Jude leads, where insulation breakdown exposes the conducting electrodes. It presents as a subtle but critical finding on chest radiographs, which clinicians must recognize to prevent serious complications. The cardiologist specifically looked for this problem based on the known lead type.
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