Five Scientific Questions for the Sonographer

Context: Patient with a single‑chamber leadless pacemaker undergoing transthoracic echocardiography.

1. Device visualization & artifacts: Can you document any acoustic shadowing or reverberation from the leadless pacemaker that limits endocardial border definition, and which windows/adjustments (e.g., harmonics, depth, focus) best minimize these artifacts?
2. Device position & seating: Is the device firmly seated on the intended right‑ventricular wall (septal vs. apical) without evidence of micro‑motion or interaction with the tricuspid apparatus? Please include measurements/images confirming location.
3. Tricuspid valve assessment: Could you quantify tricuspid regurgitation (vena contracta, PISA if applicable, hepatic‑vein systolic flow) and comment on whether the jet origin or direction suggests device‑related interference?
4. Right‑ventricular function: Please measure TAPSE, tissue‑Doppler S′ at the lateral annulus, RV fractional area change, and—if image quality permits—RV free‑wall longitudinal strain to screen for subtle RV dysfunction.
5. Complications screen: Do you see any pericardial effusion, signs suggestive of myocardial perforation, or echogenic masses/thrombus on or near the device? If present, please estimate size, location, and hemodynamic significance.

These are technical questions to guide image acquisition and reporting; final interpretation belongs to the treating cardiologist.