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Research Papers

Simulation of Mechanical Environment in Active Lead Fixation: Effect of Fixation Helix Size

[+] Author and Article Information
Xuefeng Zhao, Yi Liu, William Combs

Department of Biomedical Engineering,  Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202

Jonathan F. Wenk, Liang Ge, Julius M. Guccione

Department of Surgery and San Francisco VA Medical Center,  University of California at San Francisco, San Francisco, CA 94121

Mike Burger

 Livermore Software Technology Corporation, Livermore, CA 94550

Mithilesh K. Das

Krannert Institute of Cardiology, Roudebush VA Medical Center,  Indianapolis University School of Medicine, Indianapolis, IN 46202

Ghassan S. Kassab1

Department of Biomedical Engineering, Department of Surgery, Department of Cellular and Integrative Physiology,  Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202gkassab@iupui.edu

1

Corresponding author. Address for correspondence: 635 Barnhill Dr., Indianapolis, IN 46202.

J Biomech Eng 133(6), 061006 (Jun 28, 2011) (6 pages) doi:10.1115/1.4004288 History: Received March 14, 2011; Revised May 13, 2011; Posted May 25, 2011; Published June 28, 2011; Online June 28, 2011

The risk of myocardial penetration due to active-fixation screw-in type pacing leads has been reported to increase as the helix electrodes become smaller. In order to understand the contributing factors for lead penetration, we conducted finite element analyses of acute myocardial micro-damage induced by a pacemaker lead screw-in helix electrode. We compared the propensity for myocardial micro-damage of seven lead designs including a baseline model, three modified designs with various helix wire cross-sectional diameters, and three modified designs with different helix diameters. The comparisons show that electrodes with a smaller helix wire diameter cause more severe micro-damage to the myocardium in the early stage. The damage severity, represented by the volume of failed elements, is roughly the same in the middle stage, whereas in the later stage the larger helix wire diameter generally causes more severe damage. The onset of myocardial damage is not significantly affected by the helix diameter. As the helix diameter increases, however, the extent of myocardial damage increases accordingly. The present findings identified several of the major risk factors for myocardial damage whose consideration for lead use and design might improve acute and chronic lead performance.

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Copyright © 2011 by American Society of Mechanical Engineers
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Figures

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Figure 1

Geometric and FE models of the myocardium and the helix electrode: (a ) the myocardium with the electrode screwed in; (b ) the helix diameter, D , and helix wire diameter, d , of the electrode; (c ) the FE mesh of the myocardium; and (d ) the interface between the center and outer cylindrical meshes

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Figure 2

Cutaway view of the (a ) undeformed reference configuration, (b ) micro-damaged configuration, and (c ) penetrated configuration for the case of baseline model, i.e., D  = 0.7 mm and d  = 0.3 mm

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Figure 3

Effect of the helix wire diameter d on ((a ) and (b )) the failed volume of the myocardium and ((c ) and (d )) the contact force between the electrode and the myocardium, keeping the helix diameter the same, i.e., D  = 0.7 mm. The figures on the left have a truncated abscissa for the sake of clarity.

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Figure 4

Contour of the first (maximum) principal Almansi strain in the penetrated myocardium

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Figure 5

Effect of the helix diameter D on the failed volume of the myocardium. The helix wire diameter was kept constant, i.e., d  = 0.3 mm.

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