PA/Lateral Chest X‐Ray is Equivalent to Cine‐Fluoroscopy for the Detection of Conductor Externalization in Defibrillation Leads

Background Riata™ and Riata ST defibrillation leads (St. Jude Medical, Sylmar, CA, USA) are susceptible to insulation defects with conductor externalization. Cine‐fluoroscopy is considered to be the gold standard for the documentation of insulation defects, but similar detection rates have been reported for posterior‐anterior (PA)/lateral chest x‐ray (CXR) with zooming. Objective Prospective single‐center study to assess the diagnostic equivalence of a PA/lateral CXR with zooming for the detection of Riata insulation defects in a direct comparison to cine‐fluoroscopy. Methods Seventy‐eight consecutive patients underwent 3‐view cine‐fluoroscopy and a PA/lateral CXR. All CXRs and cine‐fluoroscopy images were reviewed by blinded electrophysiologists and staff radiologists. Results Forty‐four of 78 patients had an abnormal cine‐fluoroscopy (56%). The diagnostic correlation between PA/lateral CXR and cine‐fluoroscopy was excellent (κ = 0.90; 95% confidence interval 0.80–1.00). PA/lateral CXR was equivalent to cine‐fluoroscopy for the detection of conductor externalization showing a sensitivity of 97.7% and a specificity of 91.2%. The mean radiation effective dose of CXR was significantly lower compared to cine‐fluoroscopy (0.09 millisievert [mSV] vs 0.85 ± 0.47 mSv; P < 0.001). Also, CXR was significantly less expensive. Conclusion PA/lateral CXR with zooming is equivalent to cine‐fluoroscopy for the detection of Riata insulation defects and should be considered as the preferred screening method.