Here we see a pacer wire present in the right heart. The pacer wire appears as an echogenic linear structure in the right heart.
Image 1
The apical four-chamber view provides a view of all four heart chambers simultaneously, allowing visualization of pacemaker (defibrillator) wire. To obtain this view, place the phased array probe at the PMI, usually just below the nipple, with the probe marker oriented to patient’s right hip. Pacemaker wire will appear as an echogenic linear structure in either the right atrium or ventricle.
Clinical Importance: Pacemaker implantation is the most common surgical procedure involving the heart. Cardiac pacemakers can be single or dual-chambered, pacing the right ventricle, the right atrium, or both. The ventricular lead is usually positioned near the ventricular apex and the atrial lead is usually placed into the right atrial appendage. Malposition of pacemaker leads has been described in several different locations, including the left ventricle, the coronary sinus and other cardiac veins, the atria, and the pulmonary outflow tract. Malposition of a transvenous pacer lead in the left ventricle can lead to pulmonary embolism. Ultrasound may be used to ascertain positioning with accuracy. Also, there have been instances where pacemaker wire was mistaken for heart wall and the space between pacer wire and the ventricular wall subsequently mistaken for tamponade, leading to an erroneous and potentially fatal pericardiocentesis.
Date: August 2013