title: Simulation of LV pacemaker lead in marginal vein: potential risk factors for acute dislodgement.
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.
authors.affiliation: Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Zhao
authors.forename: Mike
authors.initials: M
authors.lastname: Burger
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.forename: Mithilesh K
authors.initials: MK
authors.lastname: Das
authors.forename: William
authors.initials: W
authors.lastname: Combs
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Wenk
authors.forename: Julius M
authors.initials: JM
authors.lastname: Guccione
authors.forename: Ghassan S
authors.initials: GS
authors.lastname: Kassab
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods; D003198:Computer Simulation; D054326:Coronary Sinus; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects; D004868:Equipment Failure; D019544:Equipment Failure Analysis / Q000379:methods*; D020342:Finite Element Analysis; D005547:Foreign Bodies / Q000209:etiology / Q000517:prevention & control; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008955:Models, Cardiovascular; D010138:Pacemaker, Artificial / Q000009:adverse effects; D018570:Risk Assessment / Q000379:methods*; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology / Q000517:prevention & control; D014680:Veins / Q000293:injuries* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology