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Prospective evaluation of cinefluoroscopy and chest radiography for Riata lead defects: implications for future lead screening

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

Lead insulation defects with externalization of the conductors exist in Riata defibrillator leads. Cinefluoroscopy is currently the gold standard to detect such defects. Prospective evaluation of alternative screening options such as chest radiography (CXR), which has been recommended by the FDA, is not well described.

Methods and results

Patients with Riata leads underwent cinefluoroscopy, CXR, and device interrogation. Leads were classified as abnormal (clear cable separation), borderline, or normal by independent evaluation of cinefluoroscopy and CXR. CXR evaluation was done in two ways as follows: (1) routine CXR read by daily staff radiologists for lead screening and (2) CXR evaluation by a radiologist educated about the lead defect. One hundred two patients were evaluated at our institution. Cinefluoroscopy showed externalized conductors in 33 patients (32 %). Twenty-five of 33 patients (76 %) who had abnormal cinefluoroscopic findings had abnormal CXR findings on blinded review by the educated radiologist. All 25 patients with abnormal CXR had abnormal findings on cinefluoroscopy. Daily staff radiologists without direct education other than prompts for lead screening detected CXR abnormalities in only 8 out of 102 (8 %) cases.

Conclusion

Cinefluoroscopy appears to be more sensitive than CXR for the detection of Riata cable extrusion. Interpretation of CXR by a radiologist with education in lead defects correlates highly with cinefluoroscopy with very high specificity. Depending on available resources for screening, CXR may be a reasonable alternative to cinefluoroscopy. Multidisciplinary collaboration across specialties (radiology and electrophysiology) can lead to improved diagnostic capability and thus the potential for enhanced quality of care.

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The authors would like to thank the cardiac electrophysiology fellowship educational program support from Medtronic, Boston Scientific, and Biotronik.

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Authors and Affiliations

  1. Clinical Cardiac Electrophysiology, Cardiac Arrhythmia Service, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 731, Providence, RI, 02903, USA

    Peem Lorvidhaya, Ivan Mendoza & Sharmila Sehli

  2. Diagnostic Imaging, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 731, Providence, RI, 02903, USA

    Michael K. Atalay

  3. Arrhythmia Service, Electrophysiology Fellowship Program, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 731, Providence, RI, 02903, USA

    Michael H. Kim

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  1. Peem Lorvidhaya
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  2. Ivan Mendoza
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  3. Sharmila Sehli
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  4. Michael K. Atalay
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Correspondence to Peem Lorvidhaya.

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Lorvidhaya, P., Mendoza, I., Sehli, S. et al. Prospective evaluation of cinefluoroscopy and chest radiography for Riata lead defects: implications for future lead screening. J Interv Card Electrophysiol 38, 131–135 (2013). https://doi.org/10.1007/s10840-013-9822-6

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  • DOI: https://doi.org/10.1007/s10840-013-9822-6

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