Medtronic chronicle lead

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Patient was seen in the ER for chest pain. History of alcohol and drug abuse.

Patient Data

Age: 55
Gender: Male

What is the expected position of RA lead?

Modality: X-ray

There is a left chest wall 2-lead ICD. The RV ICD lead overlies the RV apex. The right atrial appendage lead appears to be dislodged. There is no prior for comparison. Normal pulmonary vasculature, no consolidation, pneumothorax or pleural effusion.

Cholecystectomy clips. Prior anterior cervical spine fusion hardware noted. There are calcifications overlying the right axilla.

IMPRESSION:

Recommend cardiology consult for evaluation and position of the right atrial appendage lead and function.

Where is the RA lead here?

Modality: CT

Cardiac gated CTA was performed and consulted cardiology.

Identified is a septal hemodynamic monitoring leads in the septal portion of the RVOT. This was the expected position after discussion with cardiologist. This is the first such interesting case we have had with this device. It has since been discontinued by Medtronic and FDA.

The ICD lead is terminating as expected in RV apex.

Now there are wireless devices are available which are implanted into the left lower lobe pulmonary artery.

Case Discussion

The Chronicle system includes an implanted monitor, a pressure sensor lead which is passively fixed, an external pressure reference (EPR),with data retrieval and viewing components. The tip of the lead is placed near the right ventricular outflow tract to minimize risk of sensor tissue encapsulation.

Fewer than 200 patients got this device. Not sure how many are alive now. Now FDA in 2014 has approved a wireless implanted PA pressure monitoring device since.

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Case Information

rID: 43256
Case created: 3rd Mar 2016
Last edited: 18th Sep 2016
Systems: Cardiac, Chest
Tags: icd, pacemaker
Inclusion in quiz mode: Included

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