Use of Transesophageal Echocardiography to Improve the Safety of Transvenous Lead Extraction

Abstract

Continuous monitoring with TEE facilitates prompt diagnosis and treatment of intracardiac damage and prevents premature termination of cases with hypotension but no abnormalities on TEE.

Transesophageal echocardiography for the monitoring of transvenous lead extraction

“…Assessment of the dynamics of bleeding helps the operator make an extremely important decision whether a chest drain is required, or whether it is enough to monitor the patient if the bleeding stops. In an emergency situation usually there is no time for inserting an esophageal probe and starting diagnostic imaging [12][13][14][15][16][17][18].…”

“…The experts precisely define the role of echocardiography during the procedure and recommend the use of continuous transesophageal echocardiography or intracardiac echocardiography (ICE) as a complementary tool that increases procedure safety[1,2,4]. However, apart from the available guidelines, which are mainly expert consensus documents, there are only a few original and review papers on TEE as a monitoring tool in patients undergoing TLE[12][13][14][15][16][17][18][23][24][25]. Several case reports add valuable information to our medical knowledge[19,21,[26][27][28][29][30][31].• TLE monitoring steps with TEE TEE monitoring during TLE may be divided into four stages: preprocedural stage: from probe insertion to the start of lead dissection; stage two: navigation of lead removal; stage 3: postprocedural assessment of procedure efficacy with evaluation of possible damages, and additionally stage 4, during which TEE imaging is used for guidance of new lead placement.…”

Multiplane/3D transesophageal echocardiography monitoring to improve the safety and outcome of complex transvenous lead extractions

“…Both transesophageal echocardiography (TEE) and intracardiac echocardiography have been used to assist transvenous lead extractions (TLE) . The clinical utility of continuous echocardiographic monitoring during the procedure is still debated, with different reports supporting opposite findings . However, in selected challenging cases, TEE may alter the clinical decision or guide the intervention.…”

A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures

“…Another extremely important aspect of TEE monitoring during transvenous lead extraction is visualization of the tricuspid valve and assessment of its function. According to the available reports the incidence of significant injury to the tricuspid valve during the TLE procedure ranges from 5% to 13% and is considered a major complication of lead extraction.…”