title: PA/Lateral chest X-ray is equivalent to cine-fluoroscopy for the detection of conductor externalization in defibrillation leads.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Electrophysiology, Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ), Québec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Steinberg
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Sarrazin
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.forename: Franck
authors.initials: F
authors.lastname: Molin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Louis
authors.initials: L
authors.lastname: Blier
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Bouchard
authors.forename: Jean
authors.initials: J
authors.lastname: Arsenault
authors.forename: Gilles
authors.initials: G
authors.lastname: O'Hara
mesh_terms: D000368:Aged; D002933:Cineradiography; D017147:Defibrillators, Implantable; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods
keywords: ICD; Riata; chest x-ray; cine-fluoroscopy; conductor externalization