title: Localization of pacing and defibrillator leads using standard x-ray views is frequently inaccurate and is not reproducible.
abstract: OBJECTIVE
  While the accuracy of roentography for evaluation of lead tip position compared with three-dimensional imaging techniques has been well described, there remains considerable variability in the interpretation of the reproducibility of standard x-ray for right ventricular (RV) and left ventricular (LV) lead position. The aim of this study was to evaluate the accuracy and reliability of right ventricular (RV) and left ventricular (LV) lead tip position as determined by board-certified cardiac electrophysiologists (EP) using standard x-ray views.
  
  
  METHODS
  EP interpretations of RV and LV lead tip position using standard x-ray views (posterior-anterior, lateral, and left anterior oblique) were compared to thoracic computed tomography (CT). The accuracy of x-ray interpretation was compared to the reference CT location, and the reproducibility of x-ray interpretation was tested using the free-marginal Kappa statistic.
  
  
  RESULTS
  A total of 58 EPs were invited to participate in the survey with a response rate of 43 % (25/58). The agreement between x-ray and CT lead tip position (accuracy) was 37 % for RV lead, 33 % for longitudinal LV lead, and 41 % for short axis LV lead. Reproducibility was 64 % for RV lead tip (k = 0.46), 58 % for longitudinal LV lead tip (k = 0.37), and 39 % for short axis LV lead tip (k = 0.24).
  
  
  CONCLUSIONS
  Conventional roentography is limited in its ability to accurately and reliably determine pacing lead tip position.
authors.affiliation: Section of Cardiac Electrophysiology, Duke University School of Medicine, Durham, NC, 27705, USA, larry.jackson@dm.duke.edu.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Jackson
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Hurwitz Koweek
authors.forename: Brett D
authors.initials: BD
authors.lastname: Atwater
mesh_terms: D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015588:Observer Variation; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity