Background All implanted cardiac devices including pacemakers and defibrillators undergo regular checks in pacemaker clinics, and often fluoroscopic screening of the devices leads is performed due to changes in pacemaker parameters such as changes in threshold, impedance and sensitivity to rule out macroscopic abnormalities with the leads.
Objective The objective of this study was to review the practice of fluoroscopic lead screening and to assess whether there is any correlation between fluoroscopic findings and device parameters abnormalities that alter patient management.
Methods We retrospectively reviewed data from reporting database and clinical letters from patients notes in 2014. 64 patients were identified that underwent fluoroscopic screening procedures during 2014. Indications for screening, screening findings and recommended actions were recorded for each procedure. Screening included 40 (53%) complex devices, 24 (31%) regular bradycardia devices and 12 (16%) advisory devices including 4 Telectronics Accufix right atrial leads, and 8 St Jude Riata Right ventricular ICD leads (Table 1)
Results Fluoroscopic screening abnormalities were detected in 14 out of the 64 devices screened.There were 20 devices revision procedures performed in total. However, these were performed in only 7 (50%) of those devices that showed screening abnormalities. All these devices actually showed displaced leads on screening, and loss of capture on pacemaker check, which was the main indication for screening. Continued monitoring was recommended in the other 7 devices that showed screening abnormalities.No screening abnormalities were detected in 11 devices that required revision procedures where interventions were mainly based on different electrical issues identified.Therefore, devices interventions were driven by abnormalities detected during pacemaker checks more than abnormal screening findings. 3 procedures followed screening pre box change screening which showed normal findings.
Conclusion Fluoroscopic screening of the cardiac devices is a simple procedure for imaging the device and its leads in motion. This allows for improved visualisation of the leads and identification of small abnormalities that would otherwise be missed by still radiology tests such as x-rays. In our study, there was no correlation between electrical abnormalities that initiated lead screening, and findings on fluoroscopy. Exception was in cases of loss of capture where there was almost a consistent finding of displacement of the relevant lead, albeit the number is small to make this conclusion. We concluded that screening should continue in the following settings: (1) annual screening for advisory leads, (2) if loss of capture is detected, even though all cases were due to lead displacement, it will allow for better planning in cases where the lead is perforated through a chamber. As there is poor correlation for the rest of the indications it might be worth conducting larger review of practices to establish whether the yield from routine screening is useful. Our institution will review practices over last 5 years subsequent to this finding.
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