Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure.
Heart Rhythm
; 12(2): 313-20, 2015 Feb.
Article
in En
| MEDLINE
| ID: mdl-25311409
ABSTRACT
BACKGROUND:
Data on the use of transesophageal echocardiography (TEE) during transvenous lead extraction (TLE) procedures are scarce.OBJECTIVE:
The purpose of this study was to assess the routine use of TEE during transvenous lead extraction.METHODS:
From January 2009 to January 2014, TLE of 241 leads in 168 patients (mean age 70 ± 13 years, 129 male, left ventricular ejection fraction 37% ± 13%) was performed. Indication for TLE was lead dysfunction (56.5%), upgrade (27.0%), infection (13%), or other (3.1%). TLE techniques combined a mechanical approach amended by laser technique if required. Extraction procedures were performed with patients under general anesthesia with continuous invasive arterial blood pressure and TEE monitoring.RESULTS:
TEE was possible in all except 1 patient. TEE images in different projections were acquired and stored before and immediately after extraction of each lead. TLE was complete for 236 of 241 leads (97.9%); 4 distal lead tips (1.7%) remained in situ, and 1 dual-coil implantable cardioverter-defibrillator electrode (0.4%) could not be removed. New TEE findings after TLE were observed in 7 of 161 cases (4.3%) pericardial effusion (mild in 4 [2.5%] and severe in 1 [0.6%]) and worsening of tricuspid valve insufficiency (2 patients [1.2%]). The only case of severe pericardial effusion occurred after laceration of the superior vena cava, which required immediate rescue surgery (0.6%, confidence interval 0.01-3.3). In all other cases, TEE findings did not entail immediate diagnostic or therapeutic measures.CONCLUSION:
New TEE findings produced during TLE necessitating immediate therapeutic measures occurred in only 0.6% of cases, suggesting the limited utility of routine continuous TEE monitoring during TLE.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Catheterization, Central Venous
/
Monitoring, Intraoperative
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Defibrillators, Implantable
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Echocardiography, Transesophageal
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Device Removal
Type of study:
Observational_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
Heart Rhythm
Year:
2015
Document type:
Article
Publication country:
EEUU
/
ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
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UNITED STATES OF AMERICA
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US
/
USA