Work

Smaller defibrillation lead diameter is associated with less tricuspid regurgitation: a computational modeling study

Year: 2025

Type: article

Abstract: BACKGROUND: Tricuspid regurgitation (TR) adversely impacts mortality and hospitalizations. Transvenous pacemaker and defibrillator leads are associated with worsening TR, underscoring the need for lead designs that minimize adverse tricuspid valve interference. METHOD: We developed a physics-based computational model to evaluate the general effect of lead diameter and material stiffness on the regurgitant orifice area (ROA). Additionally, we simulated three commercial transvenous leads, with diameters of 4.7 Fr, 6.8 Fr and 8.6 Fr, and evaluated the induced ROA. Three pre-implant baseline conditions were considered in all cases: no TR, mild TR and moderate TR. RESULTS: Lead diameter exhibited a predominant effect on ROA compared to material properties. In mild and moderate TR baselines, thicker leads resulted in exponential increases in ROA. The 4.7 Fr lead remained significantly below clinically relevant increases in TR. In contrast, the 6.8 Fr and 8.6 Fr leads induced a transition from mild to moderate TR. CONCLUSIONS: Simulations support the mechanistic expectation that thinner defibrillation leads reduce mechanical interference with tricuspid leaflet coaptation, with potential implications on clinical outcomes.

Source: Expert Review of Medical Devices

DOI: 10.1080/17434440.2025.2594458

Authors: David Oks, Robert D. Schaller, Pamela K. Mason, Kevin L. Sack

Institutions: Hospital of the University of Pennsylvania, University of Virginia Health System, University of Cape Town

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Funder: Medtronic