X-ray of cardiac pacemakers

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Author: Mikael Häggström [notes 1]

Pacemaker with normally located leads in the right atrium (white arrow) and right ventricle (black arrowhead), respectively.


X-ray of the chest is often (but not always) done routinely the day after pacemaker insertion, both to check the positions of the electrodes as well as to exclude the complication of pneumothorax (see X-ray of pneumothorax).[1]


Atrial lead

For right atrial and right ventricular leads for single-chamber and dual-chamber pacemakers, the right atrial lead should demonstrate a "J-shaped" on lateral view, appearance since it curves upward and anteriorly in the right atrial appendage.[2]

Right ventricular lead

The tip of the right ventricular lead should be to the left of the spine on frontal view. In lateral view, it should course anteriorly into the apex of the right ventricle.[2]


In every X-ray where a pacemaker is present, it is apt to describe the corresponding atrium or ventricle of the electrode location, and acceptable to not comment the positioning of the electrode tip unless it is misaligned, or specifically requested in the referral.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. Kotsakou M, Kioumis I, Lazaridis G, Pitsiou G, Lampaki S, Papaiwannou A et al. (2015). "Pacemaker insertion. ". Ann Transl Med 3 (3): 42. doi:10.3978/j.issn.2305-5839.2015.02.06. PMID 25815303. PMC: 4356861. Archived from the original. . 
  2. 2.0 2.1 Aguilera, Amanda L.; Volokhina, Yulia V.; Fisher, Kendra L. (2011). "Radiography of Cardiac Conduction Devices: A Comprehensive Review ". RadioGraphics 31 (6): 1669–1682. doi:10.1148/rg.316115529. ISSN 0271-5333.