Question:
Comment on this chest X-ray.
Comment on this chest X-ray.
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Pacemaker ID on CXR:
- 1 Lead = Single chamber (usually RV apex).
- 2 Leads = Dual chamber (RA appendage + RV apex).
- 3 Leads = Biventricular/CRT (RA + RV + Coronary Sinus/LV lateral wall).
- 1 Lead = Single chamber (usually RV apex).
- 2 Leads = Dual chamber (RA appendage + RV apex).
- 3 Leads = Biventricular/CRT (RA + RV + Coronary Sinus/LV lateral wall).
Updated On: Sep 3, 2026
- TAVI
- TEVAR
- Biventricular pacemaker
- VAD
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The Correct Option is C
Solution and Explanation
Concept:
Identifying implanted cardiac devices on a chest radiograph involves examining the generator position and tracing the trajectory of the pacing or shocking leads through the venous system into the heart chambers.
Explanation:
• A standard pacemaker typically has one or two leads: one terminating in the right atrium (RA) and/or one terminating in the apex of the right ventricle (RV).
• A Biventricular pacemaker is utilized for Cardiac Resynchronization Therapy (CRT) in patients with severe heart failure and bundle branch blocks.
• On a chest X-ray, a CRT device is identifiable by the presence of a pulse generator (usually in the left pectoral region) connected to three distinct leads.
• The first lead travels to the right atrium (RA). The second lead travels to the right ventricular apex (RV). The third, unique lead travels through the right atrium, into the coronary sinus, and is advanced into a lateral cardiac vein on the epicardial surface of the left ventricle (LV).
• This third lead courses posteriorly and laterally relative to the RV lead, pacing the left ventricle to synchronize its contraction with the right ventricle.
• TAVI (Option A) would show a prosthetic valve in the aortic root. TEVAR (Option B) would show a massive stent-graft in the thoracic aorta. A VAD (Option D) involves large mechanical pump hardware and inflow/outflow cannulae positioned in the LV apex and ascending aorta.
Final Answer:
The radiographic presence of a generator with leads traversing the right atrium, right ventricle, and the coronary sinus to reach the left ventricle defines a Biventricular pacemaker.
Identifying implanted cardiac devices on a chest radiograph involves examining the generator position and tracing the trajectory of the pacing or shocking leads through the venous system into the heart chambers.
Explanation:
• A standard pacemaker typically has one or two leads: one terminating in the right atrium (RA) and/or one terminating in the apex of the right ventricle (RV).
• A Biventricular pacemaker is utilized for Cardiac Resynchronization Therapy (CRT) in patients with severe heart failure and bundle branch blocks.
• On a chest X-ray, a CRT device is identifiable by the presence of a pulse generator (usually in the left pectoral region) connected to three distinct leads.
• The first lead travels to the right atrium (RA). The second lead travels to the right ventricular apex (RV). The third, unique lead travels through the right atrium, into the coronary sinus, and is advanced into a lateral cardiac vein on the epicardial surface of the left ventricle (LV).
• This third lead courses posteriorly and laterally relative to the RV lead, pacing the left ventricle to synchronize its contraction with the right ventricle.
• TAVI (Option A) would show a prosthetic valve in the aortic root. TEVAR (Option B) would show a massive stent-graft in the thoracic aorta. A VAD (Option D) involves large mechanical pump hardware and inflow/outflow cannulae positioned in the LV apex and ascending aorta.
Final Answer:
The radiographic presence of a generator with leads traversing the right atrium, right ventricle, and the coronary sinus to reach the left ventricle defines a Biventricular pacemaker.
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