6. Discussion
Transesophageal echocardiography is a very important part of patient
evaluation before transvenous lead extraction because of its ability to
detect phenomena related to the presence of leads in the heart and
potentially affecting the course, safety and efficacy of the procedure
[1,2]. In this study the echocardiographic findings in patients with
CIEDs were divided into four basic groups: 1.tricuspid valve dysfunction
2. presence of any shadows on the leads before TLE 3. presence of excess
lead loops in the heart and 4. perforation or penetration of the lead
through the cardiac wall up to the epicardium. From the viewpoint of the
planned transvenous lead extraction, the most important findings were
the many faces of fibrosis associated with the leads varying in location
and intensity. The degree of resistance/hardness and fibrosis - the most
common enemy of the operator - appeared to determine the level of
difficulty and safety of the procedure. There is a large volume of
published studies describing the presence of mobile masses attached to
the leads visualized by TTE, TEE and ICE in asymptomatic patients
[22-23]. In this study additional masses on endocardial leads (AMEL)
were defined as fibrous connective tissue
(accretions), clots, vegetations-like massess. Similar to Golzio PG et
al. [23], we also took into consideration lead thickening and
hyperechogenicity, frequently present (29.594%) in patients undergoing
TLE (Figure 1).