The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures.
complications
effectiveness
technical difficulties
transesophageal echocardiography
transvenous leads extraction
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
30
04
2021
received:
25
02
2021
accepted:
18
05
2021
pubmed:
25
7
2021
medline:
16
10
2021
entrez:
24
7
2021
Statut:
ppublish
Résumé
Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE). Echocardiographic phenomena may determine the difficulty and safety of the procedure. 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%) and lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate 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). 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.
Sections du résumé
BACKGROUND
BACKGROUND
Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE).
HYPOTHESIS
OBJECTIVE
Echocardiographic phenomena may determine the difficulty and safety of the procedure.
METHODS
METHODS
Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed.
RESULTS
RESULTS
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%) and lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate 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
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.
Identifiants
pubmed: 34302377
doi: 10.1002/clc.23660
pmc: PMC8427997
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1233-1242Informations de copyright
© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
Références
Echocardiography. 2008 Jul;25(6):632-8
pubmed: 18652009
Eur Heart J Cardiovasc Imaging. 2014 Aug;15(8):926-32
pubmed: 24686256
J Am Coll Cardiol. 2013 Apr 2;61(13):1398-405
pubmed: 23500279
Clin Cardiol. 2021 Sep;44(9):1233-1242
pubmed: 34302377
J Clin Med. 2020 Jan 28;9(2):
pubmed: 32013032
J Invasive Cardiol. 2006 Dec;18(12):599-601
pubmed: 17197710
Eur Heart J. 2008 Dec;29(23):2886-93
pubmed: 18948356
Europace. 2018 Aug 1;20(8):1324-1333
pubmed: 29016781
J Cardiovasc Med (Hagerstown). 2019 Jun;20(6):372-378
pubmed: 30950985
Expert Rev Cardiovasc Ther. 2018 Oct;16(10):695-705
pubmed: 30118332
Eur Heart J. 2017 Oct 21;38(40):2995-3005
pubmed: 28369414
Echocardiography. 2020 Apr;37(4):601-611
pubmed: 32154950
Europace. 2018 Jul 1;20(7):1217
pubmed: 29566158
J Cardiovasc Electrophysiol. 2009 Feb;20(2):171-5
pubmed: 18775042
Echocardiography. 2019 May;36(5):980-986
pubmed: 30905087
Circulation. 2010 Oct 19;122(16):1553-61
pubmed: 20921437
Pacing Clin Electrophysiol. 2014 Oct;37(10):1297-305
pubmed: 25195955
Heart Rhythm. 2017 Dec;14(12):e503-e551
pubmed: 28919379
J Clin Med. 2020 May 08;9(5):
pubmed: 32397115
Heart Rhythm. 2009 Jul;6(7):1085-104
pubmed: 19560098
JACC Clin Electrophysiol. 2015 Oct;1(5):442-448
pubmed: 29759473
J Am Soc Echocardiogr. 2002 Sep;15(9):1027-8
pubmed: 12221430
Pacing Clin Electrophysiol. 2011 Jun;34(6):679-83
pubmed: 21303389
Clin Physiol Funct Imaging. 2021 Jan;41(1):25-41
pubmed: 32949059