Localization of pacing and defibrillator leads using standard x-ray views is frequently inaccurate and is not reproducible

  • Larry R. JacksonIIEmail author
  • Jonathan P. PicciniSr.
  • James P. Daubert
  • Lynne M. Hurwitz Koweek
  • Brett D. Atwater



While the accuracy of roentography for evaluation of lead tip position compared with three-dimensional imaging techniques has been well described, there remains considerable variability in the interpretation of the reproducibility of standard x-ray for right ventricular (RV) and left ventricular (LV) lead position. The aim of this study was to evaluate the accuracy and reliability of right ventricular (RV) and left ventricular (LV) lead tip position as determined by board-certified cardiac electrophysiologists (EP) using standard x-ray views.


EP interpretations of RV and LV lead tip position using standard x-ray views (posterior-anterior, lateral, and left anterior oblique) were compared to thoracic computed tomography (CT). The accuracy of x-ray interpretation was compared to the reference CT location, and the reproducibility of x-ray interpretation was tested using the free-marginal Kappa statistic.


A total of 58 EPs were invited to participate in the survey with a response rate of 43 % (25/58). The agreement between x-ray and CT lead tip position (accuracy) was 37 % for RV lead, 33 % for longitudinal LV lead, and 41 % for short axis LV lead. Reproducibility was 64 % for RV lead tip (k = 0.46), 58 % for longitudinal LV lead tip (k = 0.37), and 39 % for short axis LV lead tip (k = 0.24).


Conventional roentography is limited in its ability to accurately and reliably determine pacing lead tip position.


Pacing Defibrillation X-ray Accuracy Validity 



Cardiac resynchronization therapy




Left anterior oblique


Right ventricle


Left ventricle


Computed tomography



Larry R Jackson II: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article

Jonathan P. Piccini Sr.: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article

Lynne Hurwitz Koweek: concept/design, data analysis/interpretation, critical revision of article, approval of article

James P. Daubert: concept/design, critical revision of article, approval of article

Brett D. Atwater: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article


This study is a retrospective analysis of previously collected data. No patient information was obtained for the purposes of this study.


This work was not supported by any specific funding source.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Larry R. JacksonII
    • 1
    • 2
    Email author
  • Jonathan P. PicciniSr.
    • 1
    • 2
  • James P. Daubert
    • 1
    • 2
    • 5
  • Lynne M. Hurwitz Koweek
    • 3
    • 6
  • Brett D. Atwater
    • 1
    • 4
    • 5
  1. 1.Section of Cardiac ElectrophysiologyDuke University School of MedicineDurhamUSA
  2. 2.Duke Clinical Research InstituteDurhamUSA
  3. 3.Section of Cardiothoracic Imaging, Department of RadiologyDuke University School of MedicineDurhamUSA
  4. 4.Durham Veterans Administration Medical CenterDurhamUSA
  5. 5.7451 Duke North Hospital, DUMC 3174DurhamUSA
  6. 6.7451 Duke North Hospital, DUMC 3808DurhamUSA

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