Histological properties of oscillating intracardiac masses associated with cardiac implantable electric devices

Abstract

Background: There have been a few cases of echogenic cardiac implantable electric device (CIED) lead-associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients. Methods: Preoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open-heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed. Results: A total of 106 patients underwent lead removal in our institute (April 2009-March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead-related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). Conclusions: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead-associated intracardiac masses. K E Y W O R D S CIED, histology, IE, intracardiac mass, vegetation | 479 MIYAGI et Al.

Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies

“…Histopathological analysis is also performed in conjunction with CDRIE, however to a lesser extent given that mechanical devices themselves cannot be histologically processed. Lead-associated intracardiac masses in connection with positive blood cultures ( S. aureus , S. epidermidis , and Propionibacterium species) that were histologically investigated were found to be primarily composed of fresh fibrin with inflammatory cell infiltration, mostly neutrophils ( Chang et al, 2019 ; Miyagi et al, 2020 ). Although bacteria were not found histologically, the primary findings still support that intracardiac masses can be related to CDRIE since extracted masses without positive blood cultures only showed thickened endocardium and collagenous tissue ( Miyagi et al, 2020 ).…”

“…Lead-associated intracardiac masses in connection with positive blood cultures ( S. aureus , S. epidermidis , and Propionibacterium species) that were histologically investigated were found to be primarily composed of fresh fibrin with inflammatory cell infiltration, mostly neutrophils ( Chang et al, 2019 ; Miyagi et al, 2020 ). Although bacteria were not found histologically, the primary findings still support that intracardiac masses can be related to CDRIE since extracted masses without positive blood cultures only showed thickened endocardium and collagenous tissue ( Miyagi et al, 2020 ). Biopsies of intracardiac masses obtained using a triple-loop wire snare ( Salaun et al, 2017 ) or a bioptome with a steerable sheath ( Chang et al, 2019 ) with access via the femoral vein, demonstrated their diagnostic value resulting in either the continuation or discontinuation of antibiotic therapy.…”

Percutaneous lead extraction in patients with large vegetations: Limiting our aspirations

“…Not all lead‐related masses are created equal with two distinct subtypes previously described 6 . The first is composed of thickened endocardium and fibrous tissue covering the leads and ultimately forming into connective tissue.…”

“…While this tool is associated with a reduced risk of death in the setting of a superior vena cava laceration when used properly, it has also been shown to be thrombogenic during long dwell times, 5 Not all lead-related masses are created equal with two distinct subtypes previously described. 6 The first is composed of thickened endocardium and fibrous tissue covering the leads and ultimately forming into connective tissue. These masses, commonly found on leads behind the TV, are caused by a vortical flow pattern leading to low shear stress on the lead surface and provoking neointimal hyperplasia, 7 and range from small fibrous strands to large, smooth organized thrombus (Figure 1, left column).…”

Percutaneous Lead Extraction in Patients with Large Vegetations: Limiting our Aspirations

“…Not all lead-related masses are created equal with two distinct sub-types previously described. 6 The first is composed of thickened endocardium and fibrous tissue covering the leads and ultimately forming into connective tissue. These masses, commonly found on leads behind the TV, are caused by a vortical flow pattern leading to low shear stress on the lead surface and provoking neointimal hyperplasia, 7 and range from small fibrous strands to large, smooth organized thrombus (Figure, left column).…”