title: Prospective evaluation of cinefluoroscopy and chest radiography for Riata lead defects: implications for future lead screening.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Cardiac Electrophysiology, Cardiac Arrhythmia Service, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 731, Providence, RI, 02903, USA, plorvidhaya@lifespan.org.
authors.forename: Peem
authors.initials: P
authors.lastname: Lorvidhaya
authors.forename: Ivan
authors.initials: I
authors.lastname: Mendoza
authors.forename: Sharmila
authors.initials: S
authors.lastname: Sehli
authors.forename: Michael K
authors.initials: MK
authors.lastname: Atalay
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000368:Aged; D002933:Cineradiography / Q000379:methods / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D019544:Equipment Failure Analysis / Q000379:methods / Q000706:statistics & numerical data*; D005544:Forecasting; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D015588:Observer Variation; D015995:Prevalence; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012237:Rhode Island / Q000453:epidemiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016037:Single-Blind Method