X-ray Quiz 8

X-ray Quiz 8

Discussion

Dual chamber pacemaker with leads
Dual chamber pacemaker with leads

Pacemaker pulse generator is seen in the right infraclavicular region. Two leads originating from the pulse generator are tracking through the subclavian vein and superior vena cava. Atrial lead curves upwards into the right atrial appendage while the ventricular lead reaches the right ventricular apex. Each lead has two electrodes, one at the tip and another a bit proximal to it, enabling bipolar pacing. The pulse generator can be programmed to pace either in the unipolar or bipolar mode. Similarly it can be programmed in various atrial, ventricular and dual chamber pacing modes.

In addition to the pacemaker and leads, sternal suture wires are seen indicating a previous sternotomy, which could have been a coronary bypass surgery or intracardiac repair of a congenital heart disease. No prosthetic valve is visible on the image. Metals clips usually used for left internal mammary artery (LIMA) harvesting are also not visible.