Chest radiographs after permanent pacing. Are they really necessary?

The chest radiographs of 600 consecutive patients undergoing insertion of a permanent cardiac pacemaker were reviewed to determine the incidence and nature of abnormalities present. Abnormalities were detected on the chest radiographs of 131 patients (21.8%). Unsatisfactory electrode tip position and other features related to the electrode wire were commonest (14.4%). Complications related to the lungs and pleura were present in 5.5%, and those related to the generator and pouch least frequent (1.9%). Complications occurred more frequently following installation of a replacement system (48.3%) compared to new systems (17.2%). Important complications not initially detected included pneumothorax (8/15) and poor electrode loop (26/27). Chest radiographs following permanent cardiac pacing frequently demonstrate significant abnormalities whose detection is improved by awareness of their incidence and nature.