Medtronic Chronicle lead

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Acute chest pain. History of excessive alcohol and drug use.

Patient Data

Age: 55 years
Gender: Male

What is the expected position of RA lead?

Frontal CXR and CT lateral scout radiograph (as no lateral chest radiograph done).

There is a left chest wall 2-lead ICD (implantable cardioverter-defibrillator). The right ventricular (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 opinion for evaluation and position of the right atrial appendage lead and function.

Cardiac gated CTA was performed with cardiology opinion.

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 case we have had with this device. It has since been discontinued by Medtronic and FDA.

The ICD lead is terminating as expected in right ventricular apex.

Wireless devices 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, 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. 

In 2014 the FDA approved a wireless implanted PA pressure monitoring device.

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