1
|
Mian M, Khan HR. Ultrasound utilization for implantation of cardiac implantable electronic devices. Wien Klin Wochenschr 2023; 135:712-718. [PMID: 37353694 PMCID: PMC10713767 DOI: 10.1007/s00508-023-02215-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/20/2023] [Indexed: 06/25/2023]
Abstract
Ultrasound (US) guidance for implantation of cardiac implantable electronic devices (CIED) is currently not routine practice. This article sought to review published data on the use of ultrasound in each of the major surgical steps involved in implantation of CIEDs, including achieving anesthesia, obtaining venous access and implantation of leads. A literature review was performed, revealing a total of 20 peer-reviewed studies that assessed US guidance for CIED implantation; 3 of these were randomized trials while the remainder were mostly feasibility studies. The available data suggest that ultrasound can be useful in guiding implantation of CIEDs, with a trend towards less complication rates; however, more high-quality studies that compare US guidance to traditional techniques in CIED implantation are required.
Collapse
Affiliation(s)
- Muhtashim Mian
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada
| | - Habib Rehman Khan
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada.
| |
Collapse
|
2
|
Wang L, Hai T, Feng Y, Han Q, Li Y, Ju H, Jiang Y, Li X, Ze F, Liu G, Jiang L. The clinical role of transesophageal echocardiography during transvenous lead extraction. Echocardiography 2021; 38:1552-1557. [PMID: 34510520 DOI: 10.1111/echo.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/19/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is commonly used during cardiothoracic procedures. TEE has also become standard during transvenous lead extraction (TLE) procedures, but its effect and role have not been optimally defined. The goal of this study is to identify how TEE was used during TLE at our institute and review its utility. METHODS We retrospectively reviewed high-risk patients undergoing TLE, for whom more complications during extraction procedures, from June 2012 to September 2020. The patients were divided into TEE group and non-TEE group according to real-time TEE monitoring. We compared the rate of procedural success, complications between two groups and concluded the clinical utility of TEE during TLE. RESULTS A total of 195 patients were included (105 in TEE group vs 90 in non-TEE group), the rate of procedure success (97.8% vs 96.5%, p = 0.41) and complications during extraction (8.6% vs 12.2%, p = 0.40, major complication 5.7% vs 12.2%, p = 0.11, minor complication 2.9% vs 0%, p = 0.30) were comparable. In TEE group, 12 patients (11.4%) received following benefits: altering surgical plans, guiding subsequent therapy strategies, and rapidly diagnosing complications, moreover no complications occurred from TEE. CONCLUSIONS This study demonstrates that real-time monitoring by TEE cannot change the rate of procedural success and complication during TLE; however, TEE provides valuable information to instruct clinical therapy and improves the safety of TLE.
Collapse
Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Ting Hai
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - QiaoYu Han
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - YaRu Li
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Hui Ju
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yan Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - XueBin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, China
| | - Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, China
| | - Gang Liu
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China
| | - LuYang Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
3
|
Nowosielecka D, Jacheć W, Polewczyk A, Tułecki Ł, Kleinrok A, Kutarski A. The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures. Clin Cardiol 2021; 44:1233-1242. [PMID: 34302377 PMCID: PMC8427997 DOI: 10.1002/clc.23660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE). Hypothesis Echocardiographic phenomena may determine the difficulty and safety of the procedure. Methods Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. Results TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead‐to‐lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%) and lead‐dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate analysis were: fibrous tissue binding the lead to atrial wall (OR = 1.738; p < 0.05), to right ventricular wall (OR = 2.167; p < 0.001), lead‐to‐lead binding sites (OR = 1.628; p < 0.01) and excess lead loops (OR = 1.488; p < 0.05). Lead‐to‐lead binding sites increased probability of major complications (OR = 3.034; p < 0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR = 0.296; p < 0.05), right atrial wall (OR = 323; p < 0.05) and right ventricular wall (OR = 0.297; p < 0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR = 0.307; p < 0.05). Conclusions Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.
Collapse
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Wojciech Jacheć
- Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland.,Department of Physiotherapy, Medical College, University of Information Technology and Management, Rzeszów, Poland
| | | |
Collapse
|
4
|
Nowosielecka D, Jacheć W, Polewczyk A, Kleinrok A, Tułecki Ł, Kutarski A. The prognostic value of transesophageal echocardiography after transvenous lead extraction: landscape after battle. Cardiovasc Diagn Ther 2021; 11:394-410. [PMID: 33968618 DOI: 10.21037/cdt-20-871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure. Methods We analyzed data from 936 TEE performed in patients undergoing TLE between 2015 and 2019 (mean follow-up 566.23±224.47 days) and assessed the role of echocardiographic phenomena after procedure. Results Increment in tricuspid regurgitation (TR) was observed in 9% of patients after TLE. Factors increasing the risk of TR were: binding sites between lead and right ventricle (RV) (OR: 5.429), tricuspid valve (TV) (OR: 3.42), superior vena cava (SVC) (OR: 3.30) and lead-to-lead adhesions (OR: 2.88). Predisposing factors of residual structures after TLE were: asymptomatic masses on the leads (AMEL) (OR: 1.68), binding sites between SVC and cardiac structures (OR: 1.72), and multiple leads (OR: 1.30). Probability of vegetation remnants increased in the presence of abandoned leads (OR: 7.91). The risk factors of tamponade were: dwell time of the oldest lead (OR: 1.17), lead-to-lead adhesion (OR: 22.47), binding sites between lead and TV (OR: 6.08), RA (OR: 11.50), SVC (OR: 4.47), higher LVEF (OR: 2.35; P=0.006), female gender (OR: 5.43), multiple leads (OR: 2.11), looped leads (OR: 4.90) and AMEL (OR: 6.42). The risk of lead fracture was increased by: lead-to-lead adhesion (OR: 5.69), fibrosis binding the lead to RV (OR: 5.16), RA (OR: 2.39) and dwell time of the oldest lead (OR: 1.068). The mortality rate was 11.97% during follow-up. The risk of death was increased by: severe TR and vegetation remnants. Conclusions The most important phenomena evaluated after TLE are: tricuspid valve function, residual fibrosis and vegetation remnants, progression of pericardial effusion and retained lead fragments. Postoperative TEE provides information about the results of TLE and helps establish further management.
Collapse
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland
| | | |
Collapse
|
5
|
Issa ZF, Issa TZ. Utility of fluoroscopy alone for monitoring of intrathoracic bleeding complications during transvenous lead extraction. J Cardiovasc Electrophysiol 2021; 32:1724-1732. [PMID: 33709412 DOI: 10.1111/jce.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) carries a significant risk of major complications, namely bleeding into the pericardial sac or thoracic cavity. While echocardiographic imaging has been recommended for intraprocedural monitoring for those complications, no studies had examined the potential benefits of fluoroscopy alone as an alternative to echocardiography. The aim of this study was to evaluate the utility of fluoroscopy for monitoring intrathoracic bleeding complications during TLE. METHODS This is a single-center retrospective study of consecutive patients who underwent TLE of a pacemaker or ICD lead with fluoroscopy-only monitoring. At the beginning of each TLE procedure, baseline fluoroscopic images were obtained for both lung fields and the cardiac silhouette. Similar images were acquired again when hypotension develops during the procedure. RESULTS Fluoroscopy alone (without echocardiographic imaging) was used in 783 consecutive patients (54% women; average age, 71.5 ± 12.9 years) who underwent TLE. There were 93 patients (11.9%) who experienced significant hypotension. Fluoroscopy showed no obvious cause for hypotension in 63 patients. Right ventricular inversion was implied by fluoroscopy in 27 patients. Fluoroscopy detected new pericardial effusion in two patients and new right pleural effusion in one patient, which prompted halting the extraction procedure and therapeutic intervention. Additionally, routine fluoroscopic images revealed the development of an unsuspected new small left pleural effusion in one patient and a pericardial effusion in another. In-hospital mortality rate was 0%. CONCLUSIONS In selected patients undergoing TLE, fluoroscopy can provide valuable information for identifying or excluding cardiovascular causes during periods of intraprocedural hemodynamic instability.
Collapse
Affiliation(s)
- Ziad F Issa
- Prairie Heart Institute, Cardiac Electrophysiology, HSHS St. John's Hospital, Springfield, Illinois, USA
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
6
|
Burkett DA, Runciman M, Jone PN, Collins KK. Transesophageal three-dimensional echocardiographic guidance for pacemaker lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:641-650. [PMID: 33565632 DOI: 10.1111/pace.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ability of transesophageal three-dimensional echocardiography (3DE) to aid in pacemaker lead extraction has not yet been evaluated. 3DE provides real-time evaluation of intracardiac anatomy and the location of pacemaker leads in greater detail than either fluoroscopy or -two-dimensional echocardiography (2DE), aiding in the extraction of such leads, which can be potentially dangerous. We sought to investigate the feasibility and utility of 3DE to visualize intracardiac anatomy and pacemaker leads, and to assist in lead extraction procedures. METHODS We utilized 3DE in nine encounters for eight different patients, to visualize intracardiac anatomy and leads before, during, and after extraction to evaluate the feasibility and utility to aid in the procedure and evaluate for potential sequelae. RESULTS 3DE was able to identify pertinent intracardiac anatomy and leads in all cases. 3DE detected procedural complications or altered management in five of nine encounters (five of eight patients); this included detection of an avulsed papillary muscle, tricuspid valve leaflet damage, and cast/thrombus after lead removal, as well as adjustment of excess lead slack to avoid future valve damage, or risk stratification of lead removal. CONCLUSION 3DE is feasible and adds utility to lead extraction cases by visualizing intracardiac anatomy and leads beyond fluoroscopy or 2DE, providing real-time information during extraction, and identifying potential complications.
Collapse
Affiliation(s)
- Dale A Burkett
- Department of Pediatric Cardiology, Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Martin Runciman
- Department of Pediatric Cardiology, Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Department of Pediatric Cardiology, Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathryn K Collins
- Department of Pediatric Cardiology, Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
7
|
Transesophageal Echocardiography As a Monitoring Tool During Transvenous Lead Extraction-Does It Improve Procedure Effectiveness? J Clin Med 2020; 9:jcm9051382. [PMID: 32397115 PMCID: PMC7290980 DOI: 10.3390/jcm9051382] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/15/2020] [Accepted: 05/02/2020] [Indexed: 11/24/2022] Open
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.
Collapse
|
8
|
Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Tomków K, Stefańczyk P, Kleinrok A, Kutarski A. A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures. Echocardiography 2020; 37:601-611. [DOI: 10.1111/echo.14628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Anna Polewczyk
- Collegium Medicum The Jan Kochanowski University Kielce Poland
- Department of Cardiac Surgery Swietokrzyskie Cardiology Center Kielce Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology Silesian Medical University Zabrze Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Paweł Stefańczyk
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Andrzej Kleinrok
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | | |
Collapse
|
9
|
Lewis RK, Pokorney SD, Hegland DD, Piccini JP. Hands on: How to approach patients undergoing lead extraction. J Cardiovasc Electrophysiol 2019; 31:1801-1808. [DOI: 10.1111/jce.14244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Robert K. Lewis
- Cardiac Electrophysiology Section Duke University Medical Center Durham North Carolina
| | - Sean D. Pokorney
- Cardiac Electrophysiology Section Duke University Medical Center Durham North Carolina
- Duke Clinical Research Institute Durham North Carolina
| | - Donald D. Hegland
- Cardiac Electrophysiology Section Duke University Medical Center Durham North Carolina
| | - Jonathan P. Piccini
- Cardiac Electrophysiology Section Duke University Medical Center Durham North Carolina
- Duke Clinical Research Institute Durham North Carolina
| |
Collapse
|
10
|
Essandoh M, Holecko J, Warsame I, Papadimos TJ. Predictors of Intensive Care Unit Admission After Transvenous Lead Extraction: A Plea for a Risk Scoring System. J Cardiothorac Vasc Anesth 2019; 33:1852-1854. [DOI: 10.1053/j.jvca.2019.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 11/11/2022]
|
11
|
Strachinaru M, Kievit CM, Yap SC, Hirsch A, Geleijnse ML, Szili-Torok T. Multiplane/3D transesophageal echocardiography monitoring to improve the safety and outcome of complex transvenous lead extractions. Echocardiography 2019; 36:980-986. [PMID: 30905087 PMCID: PMC6593712 DOI: 10.1111/echo.14318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/11/2019] [Accepted: 02/22/2019] [Indexed: 02/02/2023] Open
Abstract
Both transesophageal echocardiography (TEE) and intracardiac echocardiography have been used to assist transvenous lead extractions. The clinical utility of continuous echocardiographic monitoring during the procedure is still debated, with different reports supporting opposite findings. In cases where the procedure is expected to be difficult, we propose adding a continuous TEE monitoring using a static 3D/multiplane probe in mid-esophageal position, with digital remote manipulation of the field of view. This approach may improve the chances of a successful extraction, increase safety, or even guide the entire intervention. We present here a short case series where continuous monitoring by TEE played an important role.
Collapse
Affiliation(s)
| | | | - Sing C Yap
- Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Cardiology, Erasmus MC, Rotterdam, The Netherlands.,Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | |
Collapse
|
12
|
Monaco F, Di Tomasso N, Landoni G, Nardelli P, Radinovic A, Melillo F, D'Angelo G, Della Bella P, Zangrillo A, Mazzone P. Predictors of Intensive Care Unit Admission in Patients Undergoing Lead Extraction: A 10-Year Observational Study in a High-Volume Center. J Cardiothorac Vasc Anesth 2019; 33:1845-1851. [PMID: 30898421 DOI: 10.1053/j.jvca.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify reliable predictors of periprocedural intensive care unit (ICU) admission after transvenous lead extraction (LE) in a high-volume center. DESIGN Retrospective observational study. SETTING University tertiary-care hospital. PARTICIPANTS All patients undergoing LE at San Raffaele Scientific Institute, Milan, Italy, from 2005 to 2015. INTERVENTIONS LE procedures were performed in the electrophysiology laboratories with a cardiac operating room on standby between the end of the morning surgical case and before the start of the afternoon surgical case. Most procedures were conducted with the patient under procedural sedation and analgesia. After LE, patients were admitted either to the ward or to the ICU. Medical history and intraprocedural data were recorded. MEASUREMENTS AND MAIN RESULTS Of the 389 procedures performed during the study period, 50 patients (13%) were admitted to the ICU owing to persistent hemodynamic instability or intraoperative complications requiring endotracheal intubation. Complete procedural success was achieved in 370 patients (95%), and the clinical success rate was 98.4%. No deaths were recorded. Five complications requiring emergency surgery (1.3%) were reported. Preprocedural right ventricular dysfunction (odds ratio (OR) 7.41; confidence interval 1.85-29.7; p < 0.01) and the need for general anesthesia (OR 12; confidence interval 1.49-97.06; p = 0.019) were independent predictors of ICU admission. CONCLUSIONS Preoperative identification of patients who need ICU admission after LE is crucial to increase patient safety and decrease hospital costs. Severe right ventricular dysfunction and need for general anesthesia identify patients with low cardiac reserve who are at increased risk for ICU admission after the procedure.
Collapse
Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Radinovic
- Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizio Mazzone
- Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
13
|
Leung LWM, Gomes J, Domenichini G, Gallagher MM. Oesophageal perforation: an unexpected complication during extraction of a pacing lead. A case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:ytz008. [PMID: 31020253 PMCID: PMC6439371 DOI: 10.1093/ehjcr/ytz008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 01/20/2019] [Indexed: 12/03/2022]
Abstract
Background Peri-procedural transoesophageal echocardiography (TOE) is important in monitoring and minimizing major complications during pacing lead extraction. It is a widely accepted precautionary measure, especially in extractions considered to be higher risk. Pacing lead extraction may be challenging, and it is associated with significant risk of major bleeding from vascular trauma. Case summary We present a case of an 87-year-old woman who had an extraction of a ventricular pacing lead that had perforated to an extra-cardiac location, most likely to the left pleural space. Peri-procedural TOE was used as a precaution. The entire pacing lead was successfully extracted with gentle traction using standard equipment (mechanical technique). Extraction was followed by development of pneumomediastinum and a left pleural effusion, initially attributed to pulmonary injury from the pacing lead but which proved to be related to oesophageal injury from the TOE. Discussion Transoesophageal echocardiography-related complications are uncommon but should be considered in cases of unexpected post-procedural deterioration. Clinical deterioration after a seemingly uneventful procedure should prompt a thorough case review. A systematic approach should be applied to identify the offending cause and enable corrective measures to be undertaken. This case report is an important reminder to all operators utilizing TOE for peri-procedural purposes that this precautionary measure itself also independently exposes the patient to additional risk.
Collapse
Affiliation(s)
- Lisa W M Leung
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Blackshaw Road, London, UK
| | - John Gomes
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Blackshaw Road, London, UK
| | - Giulia Domenichini
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Blackshaw Road, London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Blackshaw Road, London, UK
| |
Collapse
|