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Zhao X, Burger M, Liu Y, Das MK, Combs W, Wenk JF, Guccione JM, Kassab GS. Simulation of LV Pacemaker Lead in Marginal Vein: Potential Risk Factors for Acute Dislodgement. J Biomech Eng 2011; 133:031006. [DOI: 10.1115/1.4003323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although left ventricular (LV) coronary sinus lead dislodgement remains a problem, the risk factors for dislodgement have not been clearly defined. In order to identify potential risk factors for acute lead dislodgement, we conducted dynamic finite element simulations of pacemaker lead dislodgement in marginal LV vein. We considered factors such as mismatch in lead and vein diameters, velocity of myocardial motion, branch angle between the insertion vein and the coronary sinus, degree of slack, and depth of insertion. The results show that large lead-to-vein diameter mismatch, rapid myocardial motion, and superficial insertion are potential risk factors for lead dislodgement. In addition, the degree of slack presents either a positive or negative effect on dislodgement risk depending on the branch angle. The prevention of acute lead dislodgment can be enforced by inducing as much static friction force as possible at the lead-vein interface, while reducing the external force. If the latter exceeds the former, dislodgement will occur. The present findings underscore the major risk factors for lead dislodgment, which may improve implantation criterion and future lead design.
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Affiliation(s)
- Xuefeng Zhao
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202
| | - Mike Burger
- Livermore Software Technology Corporation, Livermore, CA 94550
| | - Yi Liu
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202
| | - Mithilesh K. Das
- Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - William Combs
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202
| | - Jonathan F. Wenk
- Department of Surgery and San Francisco VA Medical Center, University of California at San Francisco, San Francisco, CA 94121
| | - Julius M. Guccione
- Department of Surgery and San Francisco VA Medical Center, University of California at San Francisco, San Francisco, CA 94121
| | - Ghassan S. Kassab
- Department of Surgery, and Department of Cellular and Integrative Physiology, Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202
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Cheng A, Wang Y, Curtis JP, Varosy PD. Acute Lead Dislodgements and In-Hospital Mortality in Patients Enrolled in the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry. J Am Coll Cardiol 2010; 56:1651-6. [DOI: 10.1016/j.jacc.2010.06.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 05/13/2010] [Accepted: 06/06/2010] [Indexed: 10/18/2022]
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Adachi M, Igawa O, Inoue Y, Hisatome I. Removal of Coronary Sinus Intima by a Guidewire during Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2007; 30:1288-9. [PMID: 17897136 DOI: 10.1111/j.1540-8159.2007.00855.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previously, complications associated with the placement of the left ventricular pacing lead were reported in 1.9-6% of cases. We describe a case with a stripping of venous intima from the coronary sinus by a guidewire during a left ventricular lead implantation. Judging from this case, the firm guidewire and coronary catheter should not be used within the coronary sinus.
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Affiliation(s)
- Masamitsu Adachi
- Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University Graduate School of Medical Science, Yonago, Japan
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