Permanent pacemaker and dilated aorta on CXR

Permanent pacemaker and dilated aorta on CXR

Permanent pacemaker is seen with its lead in situ. It is a single chamber pacemaker implanted in the right pectoral region with the lead implanted by a subclavian route. The pulse generator is connected to the lead which passes through the subcutaneous tissue into the right subclavian vein and hence into the superior vena cava. The lead can be further traced into the right atrium and the right ventricle, of which the ventricular part is not clear in this image and needs a penetrated view. The aorta is dilated in this elderly person.

This is a single chamber ventricular pacemaker (VVI), though the ventricular portion of the lead is not seen here. If it was an atrial pacemaker (AAI) the lead would not have come down the lateral aspect of the right atrium, but would have been curving up into the right atrial appendage, the usual site for right atrial pacing.