In this paper, a method is presented to analyze the mechanical stress distribution in a pacing lead based on a sequence of paired 2D angiographic images. The 3D positions and geometrical shapes of an implanted pacemaker lead throughout the cardiac cycle were generated using a previously validated 3D modeling technique. Based on the Frenet–Serret formulas, the kinematic property of the lead was derived and characterized. The distribution of curvature and twist angle per unit length in the pacing lead was calculated from a finite difference method, which enabled a rapid and effective computation of the mechanical stress in the pacing lead. The analytical solution of the helix deformation geometry was used to evaluate the accuracy of the proposed numerical method, and an excellent agreement in curvature, twist angle, and stresses was achieved. As demonstrated in the example, the proposed technique can be used to analyze the complex movement and deformation of the implanted pacing lead in vivo. The information can facilitate the future development of pacing leads.

1.
McWilliam
,
J. A.
, 1889, “
Electrical Stimulation of the Heart in Man
,”
Br. Med. J.
0007-1447,
1
, pp.
348
350
.
2.
Aquilina
,
O.
, 2006, “
A Brief History of Cardiac Pacing
,”
Images Paediatr Cardiol
,
27
, pp.
17
81
.
3.
Furman
,
S.
,
Szarka
,
G.
, and
Layvand
,
D.
, 2005, “
Reconstruction of Hyman’s Second Pacemaker
,”
Pacing Clin. Electrophysiol.
0147-8389,
28
, pp.
446
453
.
4.
Beaufort-Krol
,
G. C. M.
,
Mulder
,
H.
,
Nagelkerke
,
D.
,
Waterbolk
,
T. W.
, and
Bink-Boelkens
,
M. Th. E.
, 1999, “
Comparison of Longevity, Pacing, and Sensing Characteristics of Steroid-Eluting Epicardial Versus Conventional Endocardial Pacing Leads in Children
,”
J. Thorac. Cardiovasc. Surg.
0022-5223,
117
, pp.
523
528
.
5.
Istvan
,
F. B.
, 1977, “
Endocardial Pacing Electrode
,” U.S. Patent No. 4,026,303.
6.
Alfred
,
E. M.
, 1985, “
Endocardial Electrode
,” U.S. Patent No. 4,506,679.
7.
Lars
,
B.
, 1987, “
Endocardial Electrode Arrangement
,” U.S. Patent No. 4,641,664.
8.
Ralph
,
E. H.
, 1989, “
Endocardial Pacing Lead
,” U.S. Patent No. 4,883,070.
9.
Maj
,
L. L.
, 1988, “
A 20-Year Study of Endocardial Pacing Lead EMT 588: Lead Durability and Nature of Failure
,”
Scand. Cardiovasc. J.
1401-7431,
22
(
1
), pp.
1
6
.
10.
Saha
,
A.
,
Tan
,
J.
, and
Prendergast
,
B.
, 2003, “
Pacemaker Lead Fracture
,”
Heart
1355-6037,
89
, p.
783
.
11.
Gupta
,
K.
,
Villareal
,
R. P.
,
Rasekh
,
A.
, and
Massumi
,
A.
, 2003, “
Pacemaker Lead Entrapment Syndrome
,”
Tex Heart Inst. J.
0730-2347,
30
(
1
), pp.
84
85
.
12.
Erdogan
,
O.
, and
Aktoz
,
M.
, 2007, “
Pacemaker Lead Failure Due to Crush Injury
,”
Anadolu Kardiyol Derg.
,
7
, pp.
438
440
.
13.
Chang
,
S. H.
,
Tan
,
C. K.
, and
Lee
,
S. H.
, 2009, “
Fracture of a Pacemaker Lead
,”
CMAJ
0820-3946,
181
(
11
), p.
823
.
14.
Fernandez-Gonzalez
,
A. L.
,
Bengochea
,
J. B. G.
,
Laino
,
J. C.
,
Monzoniz
,
A. M.
,
Veiras del Rio
,
S.
, and
Escudero
,
J. A.
, 2010, “
Fracture of Epicardial Resynchronization Lead Caused by Deceleration Injury
,”
Asian Cardiovascular & Thoracic Annals
,
18
(
1
), pp.
77
78
.
15.
Udyavar
,
A. R.
,
Pandurangi
,
U. M.
,
Latchumanadhas
,
K.
, and
Mullasari
,
A. S.
, 2008, “
Repeated Fracture of Pacemaker Leads With Migration Into the Pulmonary Circulation and Temporary Pacemaker Wire Insertion via the Azygous Vein
,”
J. Postgrad Med.
0022-3859,
54
(
1
), pp.
28
31
.
16.
Lam
,
C. W.
, 2001, “
Permanent Cardiac Pacemaker: An Emergency Perspective
,”
Journal of Postgraduate Medicine
,
8
, pp.
169
175
.
17.
Olgun
,
H.
,
Karagoz
,
T.
,
Celiker
,
A.
, and
Ceviz
,
N.
, 2008, “
Patient- and Lead-Related Factors Affecting Lead Fracture in Children With Transvenous Permanent Pacemaker
,”
Europace, European Society of Cardiology
,
10
, pp.
844
847
.
18.
Suga
,
C.
,
Hayes
,
D. L.
,
Hyberger
,
L. K.
, and
Lloyd
,
M. A.
, 2000, “
Is There an Adverse Outcome From Abandoned Pacing Leads?
,”
J. Interv Card. Electrophysiol.
1383-875X,
4
, pp.
493
499
.
19.
Brady
,
P. A.
,
Friedman
,
P. A.
,
Trusty
,
J. M.
,
Grice
,
S.
,
Hammill
,
S. C.
, and
Stanton
,
M. S.
, 1998, “
High Failure Rate for an Epicardial Implantable Cardioverter-Defibrillator Lead: Implications for Long-Term Follow-Up of Patients With an Implantable Cardioverter-Defibrillator
,”
J. Am. Coll. Cardiol.
0735-1097,
31
(
3
), pp.
616
622
.
20.
Kleemann
,
T.
,
Becker
,
T.
,
Doenges
,
K.
,
Vater
,
M.
,
Senges
,
J.
,
Schneider
,
S.
,
Saggau
,
W.
,
Weisse
,
U.
, and
Seidl
,
K.
, 2007, “
Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period >10 years
,”
Journal of the American Heart Association
,
115
, pp.
2474
2480
.
21.
Birnie
,
D.
,
Williams
,
K.
,
Guo
,
A.
,
Mielniczuk
,
L.
,
Davis
,
D.
,
Lemery
,
R.
,
Green
,
M.
,
Gollob
,
M.
, and
Tang
,
A.
, 2006, “
Reasons for Escalating Peacemaker Implants
,”
Am. J. Cardiol.
0002-9149,
98
, pp.
93
97
.
22.
Helguera
,
M. E.
,
Maloney
,
J. D.
,
Pinski
,
S. L.
,
Woscoboinik
,
J. R.
,
Wilkoee
,
B. L.
, and
Castle
,
L. W.
, 1994, “
Long-Term Performance of Endocardial Pacing Leads
,”
Pacing Clin. Electrophysiol.
0147-8389,
17
, pp.
56
64
.
23.
Cohen
,
L. D.
, and
Cohen
,
I.
, 1993, “
Finite-Element Methods for Active Contour Models and Balloons for 2-D and 3-D Images
,”
IEEE Trans. Pattern Anal. Mach. Intell.
0162-8828,
15
, pp.
1131
1147
.
24.
Klein
,
A. K.
,
Lee
,
F.
, and
Amin
,
A. A.
, 1997, “
Quantitative Coronary Angiography With Deformable Spline Models
,”
IEEE Trans. Med. Imaging
0278-0062,
16
, pp.
468
482
.
25.
Harrigan
,
T.
,
Kirkeelde
,
R.
,
Jalal
,
S.
,
Beveridge
,
T.
, and
Montgonery
,
B. D.
, 1996, “
Assessment of Pacing Lead Curvature and Strain With Three Dimensional Reconstruction of Biplane Cineangiographic Image In Vivo
,”
J. Am. Coll. Cardiol.
0735-1097,
27
(
2
), p.
345
.
26.
Hoffmann
,
K. R.
,
Williams
,
B. B.
,
Esthappan
,
J.
,
Chen
,
S. Y. J.
,
Carroll
,
J. D.
,
Harauchi
,
H.
,
Doerr
,
V.
,
Kay
,
G. N.
,
Eberhardt
,
A.
, and
Overland
,
M.
, 1997, “
Determination of 3-D Positions of Pacemaker Leads From Biplane Angiographic Sequences
,”
Med. Phys.
0094-2405,
24
, pp.
1854
1862
.
27.
Baxter
,
W. W.
, and
McCulloch
,
A. D.
, 2001, “
In Vivo Finite Element Model-Based Image Analysis of Pacemaker Lead Mechanics
,”
Med. Image Anal.
1361-8415,
5
, pp.
255
270
.
28.
Meagher
,
J. M.
, and
Altman
,
P.
, 1997, “
Stresses From Flexure in Composite Helical Implantable Leads
,”
Med. Eng. Phys.
1350-4533,
19
, pp.
668
673
.
29.
Altman
,
P. A.
,
Meagher
,
J. M.
,
Walsh
,
D. W.
, and
Hoffman
,
D. A.
, 1998, “
Rotary Bending Fatigue of Coils and Wires Used in Cardiac Lead Design
,”
J. Biomed. Mater. Res.
0021-9304,
43
, pp.
21
37
.
30.
Zhao
,
Y.
,
Baxter
,
W.
,
Johnson
,
B.
,
Schendel
,
M.
,
McCarty
,
J.
,
McMahon
,
C.
,
Lahm
,
R.
,
Sun
,
H.
,
Morissette
,
J.
,
Laske
,
T.
, and
Miller
,
J.
, 2003, “
The Use of Nonlinear FEA Modeling to Determine the In Vivo Stresses in Cardiac Pacing Lead Coils for Fatigue Evaluation
,”
2003 Summer Bioengineering Conference
, Sonesta Beach Resort in Key Biscayne, FL, Jun. 25–29.
31.
Chen
,
S. Y. J.
, and
Carroll
,
J. D.
, 2003, “
Kinematic and Deformation Analysis of 4-D Coronary Arterial Trees Reconstructed From Cine Angiograms
,”
IEEE Trans. Med. Imaging
0278-0062,
22
, pp.
710
721
.
32.
Millman
,
R.
, and
Parker
,
G.
, 1977,
Elements of Differential Geometry
,
Prentice-Hall
,
Englewood Cliffs, NJ
, pp.
14
41
.
33.
Kevin
,
L. M.
,
Gene
,
A. B.
, and
Anne
,
M. P.
, 2002, “
Endocardial Pacing Lead With Detachable Tip Electrode Assembly
,” U.S. Patent No. 6,459,937 B1.
34.
Yu
,
N.
,
Polycarpou
,
A. A.
, and
Johnson
,
A. J. W.
, 2004, “
Measuring Mechanical Properties of Fine-Wire Cross-Sections Used in Medical Devices
,”
J. Biomed. Mater. Res., Part B: Appl. Biomater.
1552-4973,
70B
, pp.
106
113
.
You do not currently have access to this content.