Transesophageal Echocardiography as a Monitoring Tool during Transvenous Lead Extraction—Does It Improve Procedure Effectiveness?

Abstract

Background: Transesophageal echocardiography (TEE) is a valuable tool for monitoring the patient during transvenous lead extraction (TLE), but the direct impact of TEE on the effectiveness and safety of TLE has not yet been documented. Methods: The effectiveness of TLE and short-term survival were compared between two groups of patients: 2106 patients in whom TEE was performed before and after TLE and 1079 individuals in whom continuous TEE monitoring was used. The procedure-related risk of major complications was assessed using a predictive SAFeTY TLE score. Results: The patients monitored by TEE were characterized by older age, more comorbidities and higher SAFeTY TLE scores (6.143 ± 4.395 vs. 5.593 ± 4.127; p = 0.004). Complete procedural success was significantly higher in the TEE-guided group (97.683% vs. 95.442%, p < 0.01). The rate of serious complications in the TEE-guided group was lower than the predictive SAFeTY TLE score—a reduction of 28.75% (p < 0.05). Periprocedural mortality in the TEE-guided and non-TEE-guided groups was zero vs. six deaths (p = 0.186). Short-term survival was comparable between the groups. Conclusions: Transesophageal echocardiography as a monitoring tool during transvenous lead extraction provides valuable results—higher rates of complete procedural success and a reduced risk of the most severe complications, thus preventing periprocedural deaths.

Transesophageal echocardiography for the monitoring of transvenous lead extraction

“…The results of our study for the first time confirmed higher procedural efficacy of transvenous lead extraction and reduced risk of cardiovascular injury during TLE under TEE guidance. The study also showed that continuous TEE monitoring helped achieve 100% periprocedural survival [17,18].…”

“…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].…”

“…Severe structural damage to the tricuspid valve may cause acute right ventricular failure requiring urgent valve repair [22]. TEE monitoring during TLE offers a possibility of immediate detection, localization and evaluation of the complications and sequelae, especially: pericardial tamponade, damage to the tricuspid valve and migration of the embolic material, However, TEE is a valuable imaging tool not only because of the potential for early detection of difficulties, but also because intraoperative navigation helps extractors dissect the leads slowly and gradually and observe with close scrutiny the accompanying phenomena to prevent complications at all [17,18].…”

“…Removal of adherent leads requires strong pulling on the lead and cardiac structures to which it is attached. Informing the extractor about binding sites and monitoring during dissecting sheath (polipropulene, mechanical rotational) manipulation facilitates the timely modification of the extraction technique to maximize procedure efficacy and minimize potential complications [17,18] (Fig. 2).…”

“…Our experience shows that apart from pulling on the RV there may be other causes of transient systolic blood pressure fall of ≥ 40 mmHg from baseline. Such a significant drop in blood pressure occurs after premedication and intubation, when the ostium of the superior vena cava (SVC) to the right atrium is occluded [17]. Angiodynamics, New York) to prevent pulmonary embolism [25].…”