• Heart Rhythm · Feb 2015

    Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure.

    • François Regoli, Maria Caputo, Giulio Conte, Francesco F Faletra, Tiziano Moccetti, Elena Pasotti, Tiziano Cassina, Gabriele Casso, Hervé Schlotterbeck, Albin Engeler, and Angelo Auricchio.
    • Fondazione Cardiocentro Ticino, Lugano, Switzerland. Electronic address: francois.regoli@cardiocentro.org.
    • Heart Rhythm. 2015 Feb 1; 12 (2): 313-20.

    BackgroundData on the use of transesophageal echocardiography (TEE) during transvenous lead extraction (TLE) procedures are scarce.ObjectiveThe purpose of this study was to assess the routine use of TEE during transvenous lead extraction.MethodsFrom January 2009 to January 2014, TLE of 241 leads in 168 patients (mean age 70 ± 13 years, 129 male, left ventricular ejection fraction 37% ± 13%) was performed. Indication for TLE was lead dysfunction (56.5%), upgrade (27.0%), infection (13%), or other (3.1%). TLE techniques combined a mechanical approach amended by laser technique if required. Extraction procedures were performed with patients under general anesthesia with continuous invasive arterial blood pressure and TEE monitoring.ResultsTEE was possible in all except 1 patient. TEE images in different projections were acquired and stored before and immediately after extraction of each lead. TLE was complete for 236 of 241 leads (97.9%); 4 distal lead tips (1.7%) remained in situ, and 1 dual-coil implantable cardioverter-defibrillator electrode (0.4%) could not be removed. New TEE findings after TLE were observed in 7 of 161 cases (4.3%): pericardial effusion (mild in 4 [2.5%] and severe in 1 [0.6%]) and worsening of tricuspid valve insufficiency (2 patients [1.2%]). The only case of severe pericardial effusion occurred after laceration of the superior vena cava, which required immediate rescue surgery (0.6%, confidence interval 0.01-3.3). In all other cases, TEE findings did not entail immediate diagnostic or therapeutic measures.ConclusionNew TEE findings produced during TLE necessitating immediate therapeutic measures occurred in only 0.6% of cases, suggesting the limited utility of routine continuous TEE monitoring during TLE.Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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