Echocardiographic findings in patients with cardiac implantable electronic devices-analysis of factors predisposing to lead-associated changes.

Abstract

The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined. We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high-volume centre between 2015 and 2019. The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead-to-lead adhesions, excessive lead loops, lead-dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR=1.771; p<.01) and lead dwell time (OR=1.111; p<.001). Women were more likely to have excessive lead loops (OR=1.639; p<.01), and the occurrence of loops increase with the number of implanted leads (OR=2.557; p<.001). Heart failure (OR=4.016; p<.001), lead looping (OR=2.603; p<.01) and longer cumulative lead dwell time (OR=1.017; p<.05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR=1.043; p<.001). Lead dwell time is the main factor predisposing to the occurrence of most lead-associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead-associated masses.