Echocardiographic findings in patients with cardiac implantable electronic devices-analysis of factors predisposing to lead-associated changes.
asymptomatic masses on endocardial leads
endocardial lead-related phenomena
excessive looping of the lead
fibrous binding sites between leads and cardiovascular structures
lead-dependent tricuspid dysfunction
predisposing factors
transesophageal echocardiography
vegetations
Journal
Clinical physiology and functional imaging
ISSN: 1475-097X
Titre abrégé: Clin Physiol Funct Imaging
Pays: England
ID NLM: 101137604
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
11
06
2020
revised:
27
07
2020
accepted:
09
09
2020
pubmed:
20
9
2020
medline:
2
10
2021
entrez:
19
9
2020
Statut:
ppublish
Résumé
The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined. We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high-volume centre between 2015 and 2019. The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead-to-lead adhesions, excessive lead loops, lead-dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR = 1.771; p < .01) and lead dwell time (OR = 1.111; p < .001). Women were more likely to have excessive lead loops (OR = 1.639; p < .01), and the occurrence of loops increase with the number of implanted leads (OR = 2.557; p < .001). Heart failure (OR = 4.016; p < .001), lead looping (OR = 2.603; p < .01) and longer cumulative lead dwell time (OR = 1.017; p < .05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR = 1.043; p < .001). Lead dwell time is the main factor predisposing to the occurrence of most lead-associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead-associated masses.
Sections du résumé
BACKGROUND
BACKGROUND
The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined.
METHODS
METHODS
We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high-volume centre between 2015 and 2019.
RESULTS
RESULTS
The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead-to-lead adhesions, excessive lead loops, lead-dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR = 1.771; p < .01) and lead dwell time (OR = 1.111; p < .001). Women were more likely to have excessive lead loops (OR = 1.639; p < .01), and the occurrence of loops increase with the number of implanted leads (OR = 2.557; p < .001). Heart failure (OR = 4.016; p < .001), lead looping (OR = 2.603; p < .01) and longer cumulative lead dwell time (OR = 1.017; p < .05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR = 1.043; p < .001).
CONCLUSIONS
CONCLUSIONS
Lead dwell time is the main factor predisposing to the occurrence of most lead-associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead-associated masses.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
25-41Informations de copyright
© 2020 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
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