Abstract
(1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE.
Highlights
IntroductionDue to the rising incidence of infectious and non-infectious complications related to cardiac implantable electronic devices (CIED), the number of transvenous lead extraction (TLE) procedures has been increasing [1]
Transesophageal echocardiography before transvenous lead extraction (TLE) was performed in 936 patients
On the other hand, the analysis showed several variables predicting significantly better TLE outcomes, i.e., presence of fibrous tissue binding the lead to the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040) and unexpectedly, arterial hypertension (HR = 0.569; p = 0.006). (Table 4 and Figure 7)
Summary
Due to the rising incidence of infectious and non-infectious complications related to cardiac implantable electronic devices (CIED), the number of transvenous lead extraction (TLE) procedures has been increasing [1]. TLE is considered as a first-line strategy for the management of CIED-associated complications [2,3]. The rate of major complications associated with TLE has been estimated to range from 0.9 to 4.0%, and most often there is damage to the heart or venous vessels; the lead extraction procedure carries a 0 to 0.4% risk of death [2,3]. Due to the continuous improvement in the extraction strategy, most patients with major complications are discharged from hospital in a good general
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