Three-Dimensional Analysis of the In Vivo Motion of Implantable Cardioverter Defibrillator Leads

ABSTRACT: Better understanding of the lead curvature, movement and their spatial distribution may be beneficial in developing lead testing methods, guiding implantations and improving life expectancy of implanted leads. OBJECTIVE: The aim of this two-phase study was to develop and test a novel biplane cine-fluoroscopy-based method to evaluate input parameters for bending stress in leads based on their in vivo 3D motion using precisely determined spatial distributions of lead curvatures. Potential tensile, compressive or torque forces were not subjects of this study. METHODS: A method to measure lead curvature and curvature evolution was initially tested in a phantom study. In the second phase using this model 51 patients with implanted ICD leads were included. A biplane cine-fluoroscopy recording of the intracardiac region of the lead was performed. The lead centerline and its motion were reconstructed in 3D and used to define lead curvature and curvature changes. The maximum absolute curvature C(max) during a cardiac cycle, the maximum curvature amplitude C(amp) and the maximum curvature C(max@amp) at the location of C(amp) were calculated. These parameters can be used to characterize fatigue stress in a lead under cyclical bending. RESULTS: The medians of C(amp) and C(max@amp) were 0.18 cm(−1) and 0.42 cm(−1), respectively. The median location of C(max) was in the atrium whereas the median location of C(amp) occurred close to where the transit through the tricuspid valve can be assumed. Increased curvatures were found for higher slack grades. CONCLUSION: Our results suggest that reconstruction of 3D ICD lead motion is feasible using biplane cine-fluoroscopy. Lead curvatures can be computed with high accuracy and the results can be implemented to improve lead design and testing.