Dislodged right atrial lead

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Routine chest radiograph.

Patient Data

Age: 70 years
Gender: Male

What is ideal or expected position of a right atrial lead?

X-ray

Sternotomy and mechanical bileaflet aortic valve.

Right atrial lead is not in the expected position.

X-ray

Previous position of the right atrial lead on frontal and lateral in this chest radiograph obtained 2 months earlier.

Annotated image

The correct and dislodged locations of the atrial lead tip are highlighted (blue circles).

Case Discussion

A right atrial lead should show a J-shaped curve on the frontal radiograph (anterior and superior).

It is easy to diagnose a dislodged or misplaced catheter if you have an old study to compare. The cardiologist should be informed that the lead is dislodged.

If no old study is available, then suggest this finding and recommend cardiology evaluation.

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