Figure 2
Consequences of excess ventricular lead loops on TEE examination
  1. Fluoroscopy. Ventricular lead loop in the RV cavity not affecting TV function
  2. TEE (2D ME RV Inflow-Outflow modified) Ventricular lead loop forming a closed circle, with segmental thickening
  3. TEE (3D modified) The atrial lead (yellow arrow) directed towards the RAA with a well visible distal segment and a loop formed by the ventricular lead in the RV with lead-to-lead binding site in the distal segment (red arrow)
  4. TEE (3D) Zoom in on the distal segment within the loop confirming lead-to-lead binding site (red arrow)
  5. The same as in Figure 2D
  6. TEE (3D ME – bicaval) The atrial lead (yellow arrow) implanted in the RAA wall with a visible binding site in the distal segment (blue arrow)
  7. Extracted leads surrounded by the connective tissue sheath
The presence of excess lead loops in the heart is on the one side a result of suboptimal lead positioning (no last look after the leads become lodged in the tissue), too weak tightening of the sutures, no radiological verification of lead positioning until device replacement when the mere pulling back is already impossible.
Another echocardiographic finding i.e. fibrous tissue binding the lead to the adjacent heart and vessel structures deserves discussion, as so far the problem has received scant attention in the research literature [20]. In this study, fibrous tissue binding sites were recognized on inspection of the lead location and mobility with respect to one another and cardiac structures, looking for such signs as immediate vicinity, thickening and lead/heart wall mobility during cardiac work (Figure 3).