Abstract
BackgroundThere have been a few cases of echogenic cardiac implantable electric device (CIED) lead‐associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients.MethodsPreoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open‐heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed.ResultsA total of 106 patients underwent lead removal in our institute (April 2009‐March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead‐related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients).ConclusionsTwo histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead‐associated intracardiac masses.
Highlights
On the basis of clinical trials including large populations of patients with cardiac implantable electrical devices (CIEDs), the number of cardiac implantable electric device (CIED) patients has significantly increased over the last decade.[1]
According to the 2017 HRS statements on lead management, the presence of an echocardiographic right-side intracardiac mass (ICM) on CIED leads is critical for the accurate diagnosis of CDRIE, determining the need for CIED system removal.[2]
This study showed 2 histological types of CIED lead-related ICMs
Summary
On the basis of clinical trials including large populations of patients with cardiac implantable electrical devices (CIEDs), the number of CIED patients has significantly increased over the last decade.[1]. According to the 2017 HRS statements on lead management, the presence of an echocardiographic right-side intracardiac mass (ICM) on CIED leads is critical for the accurate diagnosis of CDRIE, determining the need for CIED system removal.[2]. There have been a few cases of echogenic cardiac implantable electric device (CIED) lead-associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). Conclusions: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead-associated intracardiac masses
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