title: Intracardiac echocardiography in patients with pacing and defibrillating leads: a feasibility study.
abstract: BACKGROUND
  Lead extraction, an important and necessary component of treatment for many common device and lead-related complications, is a procedure that can provoke much anxiety in even the most experienced operators given the potentially serious complications. The principal impediment to lead extraction is the body's response to an intravascular foreign body with matrix intravascular neoformation, which causes the lead to adhere to the endocardium or vascular structure, increasing the risk of vascular or myocardial damage with lead removal. Fluoroscopic visualization, the commonly visualization used tool, has several limits in terms of anatomical structures visualization. The aim of this study was to assess the safety and feasibility of intracardiac echocardiography (ICE) in patients undergoing pacing and defibrillating leads before and during a transvenous device removal, and its potential role in detecting intracardiac leads and areas of fibrous adherence.
  
  
  METHODS
  ICE interrogation was performed in 25 consecutive patients with pacing and defibrillating implantable cardioverter defibrillators (ICD) leads before and during device removal.
  
  
  RESULTS
  A programmed ICE analysis was completed in 23 out of 25 patients with excellent resolution, providing a "qualitative-quantitative" information on anatomical structures, cardiac leads, and related areas of fibrous adherence. No ICE-related complications occurred.
  
  
  CONCLUSIONS
  ICE evaluation is safe and feasible in patients with pacing and defibrillating leads before and during transvenous lead removal, offering an excellent visualization of cardiac leads and related areas of adherence. ICE can assist pacing and ICD lead removal and could improve procedure efficacy and safety.
authors.affiliation: Cardiac and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.forename: Ezio
authors.initials: E
authors.lastname: Soldati
authors.forename: Giulio
authors.initials: G
authors.lastname: Zucchelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Arena
authors.forename: Luca
authors.initials: L
authors.lastname: Segreti
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Lucia
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D004567:Electrodes, Implanted; D019544:Equipment Failure Analysis / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018084:Ultrasonography, Interventional / Q000379:methods*