title: Superior vena cava echocardiography as a screening tool to predict cardiovascular implantable electronic device lead fibrosis.
abstract: BACKGROUND
  Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased.
  
  
  METHODS
  This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed.
  
  
  RESULTS
  62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value < 0.05). The CIED group was subdivided into 2 groups based on device implant duration (< 2 years vs. ≥ 2 years). Of the CIED implanted for ≥ 2 years, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction.
  
  
  CONCLUSIONS
  Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: S Jeffrey
authors.initials: SJ
authors.lastname: Yakish
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Arvin
authors.initials: A
authors.lastname: Narula
authors.affiliation: Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Foley
authors.affiliation: Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kohut
authors.affiliation: Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Kutalek
keywords: Cardiac implantable electronic device; Echocardiography; Lead extraction