Cardiovascular Engineering

, Volume 10, Issue 2, pp 84–90 | Cite as

New Insights into Pacemaker Lead-Induced Venous Occlusion: Simulation-Based Investigation of Alterations in Venous Biomechanics

  • Anna Lonyai
  • Anne M. Dubin
  • Jeffrey A. Feinstein
  • Charles A. Taylor
  • Shawn C. ShaddenEmail author
Technical Note


Venous obstruction is a major complication of transvenous pacemaker placement. Despite the increasing use of pacemakers and implantable cardiac defibrillators, a lack of understanding remains with regard to risk factors for the development of device-associated venous obstruction. We hypothesize that computational fluid dynamics simulations can reveal prothrombogenic locations and define thrombosis risk based on patient-specific anatomies. Using anatomic data derived from computed tomography, computer models of the superior vena cava, subclavian, innominate, and internal jugular veins were constructed for three adult patients with transvenous pacemakers. These models were used to perform patient-specific simulations examining blood flow velocity, wall shear stress, and blood pressure, both with and without the presence of the pacing leads. To better quantify stasis, mean exposure time fields were computed from the venous blood flow data. In comparing simulations with leads to those without, evident increases in stasis at locations between the leads and along the surface of the vessels closest to the leads were found. These locations correspond to regions at known risk for thrombosis. This work presents a novel application of computational methods to study blood flow changes induced by pacemaker leads and possible complications such as venous occlusion and thrombosis. This methodology may add to our understanding of the development of lead-induced thrombosis and occlusion in the clinical arena, and enable the development of new strategies to avoid such complications.


Venous occlusion Pacemaker leads Computational fluid dynamics 



The authors would like to sincerely thank Dr. Paul J. Wang for assistance with manuscript editing. This work was supported by the Stanford School of Medicine Medical Scholars Program.


  1. Bar-Cohen Y, Berul CI, Alexander ME, Fortescue EB, Walsh EP, Triedman JK, Cecchin F. Age, size, and lead factors alone do not predict venous obstruction in children and young adults with transvenous lead systems. J Cardiovasc Electrophysiol. 2006;17:754–9.CrossRefPubMedGoogle Scholar
  2. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol. 2002;25:804–8.CrossRefPubMedGoogle Scholar
  3. Dormandy JA. Influence of blood cells and blood flow on venous endothelium. Int Angiol. 1996;15:119–23.PubMedGoogle Scholar
  4. Figa FH, McCrindle BW, Bigras JL, Hamilton RM, Gow RM. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. 1997;20:1902–9.CrossRefPubMedGoogle Scholar
  5. Goudevenos JA, Reid PG, Adams PC, Holden MP, Williams DO. Pacemaker-induced superior vena cava syndrome: report of four cases and review of the literature. Pacing Clin Electrophysiol. 1989;12:1890–5.CrossRefPubMedGoogle Scholar
  6. Haghjoo M, Nikoo MH, Fazelifar AF, Alizadeh A, Emkanjoo Z, Sadr-Ameli MA. Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade. Europace. 2007;9:328–32.CrossRefPubMedGoogle Scholar
  7. Korkeila P, Nyman K, Ylitalo A, Koistinen J, Karjalainen P, Lund J, Airaksinen KE. Venous obstruction after pacemaker implantation. Pacing Clin Electrophysiol. 2007;30:199–206.CrossRefPubMedGoogle Scholar
  8. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–181.Google Scholar
  9. Marsden AL, Bernstein AJ, Reddy VM, Shadden SC, Spilker RL, Chan FP, Taylor CA, Feinstein JA. Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics. J Thorac Cardiovasc Surg. 2009;137:394–403 e392.Google Scholar
  10. Mazzetti H, Dussaut A, Tentori C, Dussaut E, Lazzari JO. Superior vena cava occlusion and/or syndrome related to pacemaker leads. Am Heart J. 1993;125:831–7.CrossRefPubMedGoogle Scholar
  11. Mohiaddin RH, Wann SL, Underwood R, Firmin DN, Rees S, Longmore DB. Vena caval flow: assessment with cine MR velocity mapping. Radiology. 1990;177:537–41.PubMedGoogle Scholar
  12. Nohe B, Johannes T, Schmidt V, Schroeder TH, Kiefer RT, Unertl K, Dieterich HJ. Effects of reduced shear stress on inflammatory reactions in vitro. Effects of pathological flow conditions on leukocyte-endothelial interactions and monocyte tissue factor expression in human cell cultures. Anaesthesist. 2005;54:773–80.CrossRefPubMedGoogle Scholar
  13. Oginosawa Y, Abe H, Nakashima Y. The incidence and risk factors for venous obstruction after implantation of transvenous pacing leads. Pacing Clin Electrophysiol. 2002;25:1605–11.CrossRefPubMedGoogle Scholar
  14. Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, Francis C. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol. 2005;13:9–19.CrossRefPubMedGoogle Scholar
  15. Smith HJ, Fearnot NE, Byrd CL, Wilkoff BL, Love CJ, Sellers TD. Five-years experience with intravascular lead extraction. US lead extraction database. Pacing Clin Electrophysiol. 1994;17:2016–20.CrossRefPubMedGoogle Scholar
  16. Sticherling C, Chough SP, Baker RL, Wasmer K, Oral H, Tada H, Horwood L, Kim MH, Pelosi F, Michaud GF, Strickberger SA, Morady F, Knight BP. Prevalence of central venous occlusion in patients with chronic defibrillator leads. Am Heart J. 2001;141:813–6.CrossRefPubMedGoogle Scholar
  17. Taylor CA, Hughes TCR, Zarins CK. Finite element modeling of blood flow in arteries. Comput Methods Appl Mech Eng. 1998a;158:155–96.CrossRefGoogle Scholar
  18. Taylor CA, Hughes TJ, Zarins CK. Finite element modeling of three-dimensional pulsatile flow in the abdominal aorta: relevance to atherosclerosis. Ann Biomed Eng. 1998b;26:975–87.CrossRefPubMedGoogle Scholar
  19. Taylor CA, Draney MT, Ku JP, Parker D, Steele BN, Wang K, Zarins CK. Predictive medicine: computational techniques in therapeutic decision-making. Comput Aided Surg. 1999;4:231–47.CrossRefPubMedGoogle Scholar
  20. van Rooden CJ, Molhoek SG, Rosendaal FR, Schalij MJ, Meinders AE, Huisman MV. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. J Cardiovasc Electrophysiol. 2004;15:1258–62.CrossRefPubMedGoogle Scholar
  21. Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol. 1999;33:1671–6.CrossRefPubMedGoogle Scholar
  22. Wilkoff BL, Belott PH, Love CJ, Scheiner A, Westlund R, Rippy M, Krishnan M, Norlander BE, Steinhaus B, Emmanuel J, Zeller PJ. Improved extraction of ePTFE and medical adhesive modified defibrillation leads from the coronary sinus and great cardiac vein. Pacing Clin Electrophysiol. 2005;28:205–11.CrossRefPubMedGoogle Scholar
  23. Wilson N, Wang K, Dutton R, Taylor CA. A software framework for creating patient specific geometric models from medical imaging data for simulation based medical planning of vascular surgery. Lect Notes Comput Sci. 2001;2208:449–56.CrossRefGoogle Scholar
  24. Wilson NM, Arko FR, Taylor CA. Predicting changes in blood flow in patient-specific operative plans for treating aortoiliac occlusive disease. Comput Aided Surg. 2005;10:257–77.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Anna Lonyai
    • 1
  • Anne M. Dubin
    • 2
  • Jeffrey A. Feinstein
    • 2
    • 3
  • Charles A. Taylor
    • 3
  • Shawn C. Shadden
    • 4
    Email author
  1. 1.School of MedicineStanford UniversityPalo AltoUSA
  2. 2.Department of Pediatrics–Division of CardiologyStanford UniversityPalo AltoUSA
  3. 3.Department of BioengineeringStanford UniversityPalo AltoUSA
  4. 4.Mechanical, Materials and Aerospace EngineeringIllinois Institute of TechnologyChicagoUSA

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