Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction

Abstract

(1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE.

The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

“…The process of natural maturation makes lead-related fibrotic scar harder and harder leading to its mineralization and calcification. It is well-known that scar tissue in the SVC and in the heart makes lead dissection more difficult [ 34 ]. However, so far, nobody has considered scar tissue causing LRVSO and scar tissue around the leads detected during TEE/ICS as the same phenomenon.…”

Risk Factors for Lead-Related Venous Obstruction: A Study of 2909 Candidates for Lead Extraction

“…The role of thrombosis in delayed (months) or late (years) LRVSO is less clear [ 23 ]. The inflammatory response of the vessel wall probably incites the formation of scar tissue similar to the scar binding the lead to the vessel and heart structures detected around the extracted leads and on TEE (multiple ghosts) [ 31 , 32 , 33 , 34 , 35 ]. In this aspect, permanent anticoagulation may reduce the risk of early thrombosis [ 5 , 11 ] but it has no impact on the subsequent formation of the connective tissue.…”

The clinical role of transesophageal echocardiography during transvenous lead extraction

“…We summarized the important utility of TEE from a clinically practical view to instruct the anesthetic management during TLE, actually TEE has some other potentials and benefits. Preoperative echocardiographic findings on vegetations and fibrous tissue binding sites between the lead and surrounding structures during TLE can predict the long‐term prognosis 19 . An analysis of 936 TLE procedures with continuous TEE monitoring demonstrated the perioperative guidance of TEE in detail, and concluded factors predisposing to lead‐associated changes visualized by TEE 20,21 …”