Clinical utility of intraprocedural transesophageal echocardiography during transvenous lead extraction.
BACKGROUND
Transvenous lead extraction carries a risk of significant complications. Although intraoperative transesophageal echocardiography (TEE) is widely used to monitor cardiac performance and structures, its utility during transvenous lead extraction has not been well described.


OBJECTIVE
This study evaluates the utility of TEE during transvenous lead extraction.


METHODS
The records of 108 consecutive patients who underwent transvenous lead extraction with TEE guidance were reviewed.


RESULTS
Transvenous extraction of 202 leads was attempted; complete extraction was achieved for 174 leads (86%) and partial extraction for 13 leads with clinically acceptable outcomes in 187 leads (93%). Mean age of the patients was 63 +/- 21 (14-99) years and 37% were female. The average number of leads per patient was 1.9 (1-6). Mean implant duration was 71 +/- 57 (1-360) months. Indications for extraction were pocket infection (53 patients), bacteremia (33), atrial J-lead fracture or recall (13), lead malfunction (8), and venous thrombosis (1). TEE identified critical findings that prompted emergency surgical intervention or converted transvenous lead extraction to surgical explantation in 6 patients (two cases with cardiac laceration, 3 cases of cardiac tamponade, and one case with a large vegetation and a patent foramen ovale). TEE eliminated the need for the premature termination of the procedure in 11 patients by excluding significant structural cardiac damage. Overall, TEE provided clinically useful information during transvenous lead extraction in 17 cases (16%).


CONCLUSIONS
TEE during transvenous lead extraction provides valuable real-time information that improves efficacy and safety.
Endo
Yuka
Y
Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA. yuka.endo@snhmc.org
O'Mara
John E
JE
Weiner
Stanislav
S
Han
Jennifer
J
Goldberger
Mark H
MH
Gordon
Garet M
GM
Nanna
Michele
M
Ferrick
Kevin J
KJ
Gross
Jay N
JN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome