Introduction
Transesophageal echocardiography (TEE) is a useful tool in preoperative
observation of patients undergoing transvenous leads extraction (TLE)
due to complications associated with implanted devices.
Echocardiographic phenomena may determine the safety of the procedure.
Methods and results
Data from 936 transesophageal examinations (TEE) performed at a high
volume center in patients awaiting TLE from 2015 to 2019 were assessed.
TEE revealed a total of 1156 phenomena associated with the implanted
leads in 697 (64.85%) patients, including: asymptomatic masses on
endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous
tissue binding the lead to the vein or heart wall (33.76%),
lead-to-lead binding sites (18.38%), excess lead loops (19.34%),
intramural penetration of the lead tip (16.13%), lead-dependent
tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical
difficulties during TLE in multivatiate analysis were: fibrous tissue
binding the lead to atrial wall (OR=1.738; p<0.05), to right
ventricular wall (OR=2.167; p<0.001), lead-to-lead binding
sites (OR=1.628; p<0.01) and excess lead loops (OR=1.488;
p<0.05). Lead-to-lead binding sites increased probability of
major complications (OR=3.034; p<0.05). Presence of fibrous
tissue binding the lead to the superior vena cava (OR=0.296;
p<0.05), right atrial wall (OR=323; p<0.05) and
right ventricular wall (OR=0.297; p<0.05) reduced the
probability of complete procedural success, whereas fibrous tissue
binding the lead to the tricuspid apparatus decreased the probability of
clinical success (OR=0.307; p<0.05),
Conclusions :
Careful preoperative TEE evaluation of the consequences of extended lead
implant duration (enhanced fibrotic response) increases the probability
of predicting the level of difficulty of TLE procedures, their efficacy
and risk of major complications.
Key words: transvenous leads extraction, effectiveness,
complications, transesophageal echocardiography