Presentation
Status post leadless pacemaker implantation for sick sinus syndrome in the setting of atrial fibrillation. Chest radiographs performed to check initial device position.
Patient Data
- A 2.6 cm X 0.7 cm sized radio-opaque metallic capsule projects over the right ventricle (anteriorly on the lateral view), consistent with a Micra leadless intracardiac permanent pacemaker. The dense distal "dot" is the most characteristic finding to identify a leadless pacemaker (magnified image # 3) on plain radiography.
- Moderately severe cardiomegaly and atherosclerotic calcifications in the thoracic aorta.
- No focal pneumonia. Small left pleural effusion. No pneumothorax.
- No acute osseous findings. The upper abdomen appears normal.
Case Discussion
Chest radiographs confirmed appropriate positioning of the leadless pacemaker within the right ventricle.
Leadless pacemakers were developed to minimize lead and pocket-related complications, such as infection. They consist of a self-contained generator and electrode. This patient has the Medtronic Micra (25.9 mm x 6.7 mm), which is a right ventricular single-ventricle pacemaker implanted via a percutaneous femoral catheter-based approach. Another leadless pacemaker, the Abbott Nanostim (42.0 mm x 5.99 mm), was previously in use but has since been recalled.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
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