Transesophageal echocardiography for the monitoring of transvenous lead extraction

Nowosielecka, Dorota; Polewczyk, Anna; Jacheć, Wojciech; Kleinrok, Andrzej; Tułecki, Łukasz; Kutarski, Andrzej

doi:10.33963/kp.15651

Cited by 13 publications

(34 citation statements)

References 42 publications

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“…The role of continuous TEE monitoring during TLE procedures was discussed in previous publications. [16][17][18][19][20][21] Due to economic and organizational problems, many TLE centers use a graded approach in the application of safety requirements: from TLE in the cath-lab, in deep analgesia-sedation, through TLE in the operating room/ hybrid room with general anesthesia in the presence of a cardiac surgeon along with additional monitoring of the procedure (TEE, arterial line). Several predictors of major complications or even indicators have been proposed for pre-operative selection of the appropriate degree of protection.…”

Section: Discussionmentioning

confidence: 99%

“…The echocardiographic probe was inserted after the patient was intubated. TEE monitoring was performed in the following stages: 1) pre-procedural assessment 2) intra-procedural phase -procedure monitoring, and 3) post-procedural phase to evaluate the impact of TLE on tricuspid valve function, retention of lead fragments, vegetation remnants and delayed fluid (blood) accumulation in the pericardial space [16][17][18][19] (Figure 2).…”

Section: Echocardiographic Monitoringmentioning

confidence: 99%

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Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Stefańczyk¹,

Nowosielecka²,

Tułecki³

et al. 2021

VHRM

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Background: Transvenous lead extraction (TLE) is now a first-line technique for the treatment of complications related to cardiac implantable electronic devices. The aim of the study was to demonstrate that it is possible to safely perform difficult TLE procedures with a maximum reduction of peri-procedural major complications. Methods: A total of 1000 consecutive patients undergoing TLE in a single high-volume center from 2016 to 2019 were studied. All procedures were performed in a hybrid room or operating room by a specialized TLE team. TLE was performed under general anesthesia and monitored by transesophageal echocardiography, and the operating room was suitably equipped for immediate surgical intervention. The effectiveness and safety of the procedures were assessed, with particular emphasis on major complications. Results: In all, 1952 leads with the mean implant duration of 111.7 ± 77.6 months had been extracted. Complete procedural success of patients was achieved in 95.9% and clinical success in 99.1%. Major complications, predominantly cardiac tamponade (63.3%), occurred in 22 patients (2.2%). Rapid diagnosis and immediate intervention were the key to a 100% survival in patients with this complication. Conclusion:Performing procedures in a hybrid operating room under general anesthesia in the presence of a cardiac surgeon and with the use of transesophageal echocardiography significantly improves the safety of transvenous lead extraction.

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Section: Discussionmentioning

confidence: 99%

Section: Echocardiographic Monitoringmentioning

confidence: 99%

Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Stefańczyk¹,

Nowosielecka²,

Tułecki³

et al. 2021

VHRM

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“…As leads or important information move out of the single plane, the ability of 2DE to identify anatomy or complications rapidly dwindles. This is noteworthy given the documented utility of 2DE TEE during lead extraction to demonstrate and even reduce complications associated with the procedure, and also improve procedural success 5–11 . However, even when something is within view, 2DE can still be suboptimal compared to 3DE, as evidenced by the fact that experienced echocardiographers frequently have difficulty in accurately identifying something as simple as TV leaflets by 2DE 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Although fluoroscopy can detail the cardiac silhouette, catheters and pacemaker leads well, it poorly demonstrates pertinent intracardiac anatomy for pacemaker leads. In contrast, transesophageal two‐dimensional echocardiography (2DE) details intracardiac anatomy well and has been shown to have benefit in pacemaker lead removal/extraction cases given the ability to document the tricuspid valve (TV), cardiac function and filling, pericardial space, and thrombus formation that might complicate such cases 1–7 . Based on available data, the Heart Rhythm Society expert consensus on lead extraction notes that 2DE can: identify cardiovascular causes of hemodynamic instability; identify critical findings, prompting surgical intervention; prevent premature procedure termination; exclude cardiovascular causes of hypotension; identify vegetations; identify TV function; and identify pericardial effusions 8–11 .…”

Section: Introductionmentioning

confidence: 99%

Transesophageal three‐dimensional echocardiographic guidance for pacemaker lead extraction

Burkett

Runciman

Jone

et al. 2021

Pacing Clinical Electrophis

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Background The ability of transesophageal three‐dimensional echocardiography (3DE) to aid in pacemaker lead extraction has not yet been evaluated. 3DE provides real‐time evaluation of intracardiac anatomy and the location of pacemaker leads in greater detail than either fluoroscopy or –two‐dimensional echocardiography (2DE), aiding in the extraction of such leads, which can be potentially dangerous. We sought to investigate the feasibility and utility of 3DE to visualize intracardiac anatomy and pacemaker leads, and to assist in lead extraction procedures. Methods We utilized 3DE in nine encounters for eight different patients, to visualize intracardiac anatomy and leads before, during, and after extraction to evaluate the feasibility and utility to aid in the procedure and evaluate for potential sequelae. Results 3DE was able to identify pertinent intracardiac anatomy and leads in all cases. 3DE detected procedural complications or altered management in five of nine encounters (five of eight patients); this included detection of an avulsed papillary muscle, tricuspid valve leaflet damage, and cast/thrombus after lead removal, as well as adjustment of excess lead slack to avoid future valve damage, or risk stratification of lead removal. Conclusion 3DE is feasible and adds utility to lead extraction cases by visualizing intracardiac anatomy and leads beyond fluoroscopy or 2DE, providing real‐time information during extraction, and identifying potential complications.

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“…All recordings were archived and, in accordance with the guidelines, included a preoperative examination, navigation during TLE, and postoperative evaluation of the effectiveness of the procedure with an assessment of possible complications. [28][29][30][31]. The projections and consecutive stages of echocardiographic monitoring were described in detail in previous publications [28][29][30][31].…”

Section: Tee Monitoring During Tlementioning

confidence: 99%

Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

Tułecki

Polewczyk

Jacheć³

et al. 2021

IJERPH

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Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.

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Transesophageal echocardiography for the monitoring of transvenous lead extraction

Cited by 13 publications

References 42 publications

Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Transesophageal three‐dimensional echocardiographic guidance for pacemaker lead extraction

Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

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