title: Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure.
abstract: BACKGROUND
  Data on the use of transesophageal echocardiography (TEE) during transvenous lead extraction (TLE) procedures are scarce.
  
  
  OBJECTIVE
  The purpose of this study was to assess the routine use of TEE during transvenous lead extraction.
  
  
  METHODS
  From 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.
  
  
  RESULTS
  TEE 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.
  
  
  CONCLUSIONS
  New 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.
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland. Electronic address: francois.regoli@cardiocentro.org.
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Caputo
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Francesco F
authors.initials: FF
authors.lastname: Faletra
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Pasotti
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Cassina
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Casso
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Hervé
authors.initials: H
authors.lastname: Schlotterbeck
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Albin
authors.initials: A
authors.lastname: Engeler
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior
keywords: Cardiac implantable device; Lead extraction procedure; Lead management; Transesophageal echocardiography monitoring; Transvenous lead extraction