Simulation of mechanical environment in active lead fixation: effect of fixation helix size.
Simulation of mechanical environment in active lead fixation: effect of fixation helix size.
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主动引线固定中的机械环境模拟：固定螺旋尺寸的影响。
DOI：
10.1115/1.4004288
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Kassab,GhassanS
中科院分区：
文献类型：
--
作者：
Zhao,Xuefeng;Wenk,JonathanF;Burger,Mike;Liu,Yi;Das,MithileshK;Combs,William;Ge,Liang;Guccione,JuliusM;Kassab,GhassanS
据报道，随着螺旋电极的变小，主动固定旋入式起搏电极导致心肌穿透的风险增加。为了了解导线穿透的影响因素，我们对起搏器螺旋电极引起的急性心肌微损伤进行了有限元分析。我们比较了七种导联设计的心肌微损伤倾向，包括基线模型，三种不同螺旋钢丝横截面直径的改良设计，以及三种不同螺旋直径的改良设计。比较发现，螺旋线直径越小的电极，早期对心肌的微损伤越严重。以失效元件体积表示的损伤严重程度在中期大致相同，而在后期，螺旋线直径越大，损伤通常越严重。螺旋直径对心肌损伤的发生无显著影响。然而，随着螺旋直径的增加，心肌损伤的程度也相应增加。目前的发现确定了心肌损害的几个主要危险因素，考虑使用和设计铅可能会改善急性和慢性铅的表现。
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.