Three-Dimensional Reconstruction of Pacemaker Lead Trajectory From Orthogonal Chest X-Rays: A Proof of Concept.

Understanding the lead trajectory is important in preventing complications after cardiac rhythm device implantation. In this report, we sought to reconstruct the three-dimensional (3D) shape of a pacing lead from radiographs taken at 90-degree angles. All image data were obtained from a 65-year-old male patient, who underwent pacemaker implantation at our hospital due to third-degree atrioventricular block in 2016. Both frontal and lateral chest X-rays were taken just after the device implantation (supine position) and on the post-procedural day 1 (upright position), respectively. Fluorine-18-fluorodeoxyglucose positron emission tomography/CT was performed 75 days after the pacemaker implantation for the diagnosis of cardiac sarcoidosis. Contours of the ventricular leads were manually traced in each X-ray image and saved as Scalable Vector Format (SVG) files using the GNU Image Manipulation Program (GIMP). The 3D reconstruction was performed on Blender 2.93, which is an open-source computer graphics software. The lead trajectory could be reconstructed from bidirectional radiographs, which may allow for further investigation of the 3D shape change of the pacemaker leads.