Cardiac rhythm device identification algorithm using X-Rays: CaRDIA-X.

Introduction A 75-year-old woman with a dual-chamber pacemaker was seen in the cardiology clinic for possible device malfunction. The patient’s device identification card revealed that a pacemaker from “Manufacturer A” was implanted in 2001. However, device interrogation using the corresponding programmer failed to communicate with the device. Given the age of the device, complete depletion of the battery was suspected and the patient was thus referred for pacemaker generator change. On the day of the surgery in the holding area, upon inspection of the pacemaker implantation site, existence of 2 healed scars side by side raised the suspicion of a previous generator change out or revision of leads. However, the patient did not recall any such procedures; therefore all of the 5 major manufacturers were contacted. Manufacturer A confirmed the information in the identification card, whereas the others showed no record of the patient. Nevertheless, the second scar at the device site still remained a question. Although the decision regarding the pacemaker generator change was acceptable, the possibility of a mistaken device manufacturer identity could not be completely ruled out. The patient’s chest X-ray with the pacemaker image was compared with other patients’ X-rays with known pacemakers for possible manufacturer identification. Similarities with one of the other manufacturer’s (“Manufacturer B”) X-ray pacemaker image prompted device in-