Implantable cardiac devices and the chest radiograph: what can we learn?

This narrative vignette illustrates how a plain chest radiograph can be useful in identifying implantable cardiac devices and, therefore, informing clinical management. We present a fictitious case of a 72-year-old gentleman who attends the emergency department with acute severe abdominal pain and clinical signs of sepsis. Following imaging and surgical review, he is booked for an emergency laparotomy. In view of the patient being too unwell to give a full history, the information available is very limited. It soon transpires that he has an implantable cardiac device. In the context of emergency surgery being required, we illustrate how a systematic approach to analysing the appearance of an implantable cardiac device on a plain chest radiograph can provide valuable information and help inform perioperative management. We also discuss limitations in the amount of information that can be obtained from chest radiographs, for instance, battery status or specific details of device programming, such as pacing rate threshold, cannot be acquired by these means. We discuss various devices and their common appearance on chest radiographs to demonstrate how, in emergency surgical settings where patient information may be limited, chest radiography serves as a useful tool for identifying implantable cardiac devices and guiding perioperative management. We illustrate how, through a systematic approach to interpretating radiographs, decisions can be informed with regard to device interrogation, magnet application and intraoperative precautions, thereby effecting greater patient safety.