Algorithm for the analysis of pre-extraction computed tomographic images to evaluate implanted lead–lead interactions and lead–vascular attachments

Mikayle A. Holm, Pierce J. Vatterott, Erik N. Gaasedelen, Imran Syed, Akbar Khan, Tinen L. Iles, Paul A. Iaizzo

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: The number of lead extractions is growing because of the greater population and increasing age of individuals with a cardiac implantable electronic device. Lead extraction procedures can be complex undertakings with risk of significant mortality, and vascular tears in the superior vena cava are of greatest concern. Objective: The purpose of this study was to study whether a novel algorithm that analyzes pre-extraction computed tomographic (CT) images can determine the likelihood and location of lead–lead interactions and lead–vessel attachment within patients’ venous vasculatures. This information can be used to identify potential case challenges in the planning stages. Methods: We developed an algorithm to estimate the presence and position of lead–lead interactions and lead–vessel adherences by tracking distance between the leads and distance between the lead and superior vena cava in a sample of 12 patients referred to the United Heart and Vascular Clinic for lead extractions due to infection (n = 5), lead failure (n = 5), and tricuspid regurgitation (n = 2). Results: Preliminary results indicate that the developed algorithm successfully identified lead–lead and lead–vascular attachments compared to review of CT images by medical experts. Conclusion: With future validation and clinical implementation, this algorithm could aid physician preparedness by minimizing intraprocedural emergencies and may improve patient outcomes.

Original languageEnglish (US)
Pages (from-to)1009-1016
Number of pages8
JournalHeart Rhythm
Issue number6
StatePublished - Jun 2020

Bibliographical note

Funding Information:
This work was supported by the Institute for Engineering in Medicine at the University of Minnesota. The sponsor did not play a role in study design, data collection/analysis/interpretation, report writing, or decision to submit for publication.

Publisher Copyright:
© 2020 Heart Rhythm Society


  • Algorithm
  • Case planning
  • Computed tomographic imaging
  • Lead extraction
  • Patient safety

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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