• Mouhannad M Sadek, Joshua M Cooper, David S Frankel, Pasquale Santangeli, Andrew E Epstein, Francis E Marchlinski, and Robert D Schaller.
• Arrhythmia Service, Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
• Heart Rhythm. 2017 Dec 1; 14 (12): 1779-1785.

BackgroundTransvenous lead extraction (TLE) carries a significant risk of intraprocedural complications. Phased-array intracardiac echocardiography (ICE) is widely used during cardiac procedures; however, its utility during TLE has not been well described.ObjectiveWe sought to define the utility of ICE imaging during TLE.MethodsFifty patients referred for TLE were included. Patients underwent ICE imaging before and throughout TLE. Clinical characteristics of the patients, ICE findings, and procedural outcomes were collected and analyzed.ResultsOf the 50 patients, 18 (36%) were found to have visible binding sites in the ICE field of view; 13 (26%) had intracardiac binding sites only, and 5 (10%) had both superior vena cava (SVC) and intracardiac binding sites. Lead-adherent echodensities (LAEs) were found in 36 patients (72%), of whom 7 (14%) had bacteremia. Patients with SVC and/or intracardiac binding sites were more likely to have a complex extraction, defined as that requiring the use of internal jugular or femoral venous access, advancement of extraction apparatus beyond the SVC, disruption of lead structure during the procedure, or resulting in major complications (56% vs 0%; P ≤ .0001).ConclusionICE imaging during TLE can be used to assess the presence of lead binding sites, LAEs, and procedural complications. LAEs were found in the majority of patients, mostly in the absence of bacteremia. The presence of ICE-detected lead binding sites is predictive of a more complex extraction procedure.Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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