Spectral computed tomography (SCT) after cardiovascular electronic devices implantation: No more blinding lights

Accurate localization of intraventricular electrode tips in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a challenge, necessitating advanced imaging techniques. Traditional methodologies, such as Chest X-ray (CXR) and echocardiography, may prove insufficient in precisely determining electrode positions. ECG-gated contrast enhanced coronary Computed Tomography (CT) angiography provides the clearest assessment of lead position relative to the myocardium but its effectiveness can be seriously compromised by metallic artifacts. In this scenario, Spectral Computed Tomography (SCT) imaging stands out as a promising solution, offering artifact reduction and enhanced tissue contrast, in particular with “iodine no water” images. In this report, we present a compelling case that highlights the effectiveness of DECT in precisely locating an intraventricular electrode tip, thereby illustrating its potential value in clinical practice. Our findings advocate for the integration of SCT into the diagnostic algorithm for comprehensive cardiac device management, facilitating non-invasive patient follow-up and minimizing the need for additional and invasive procedures.