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The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures
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  • Dorota Nowosielecka,
  • Wojciech Jacheć,
  • Anna Polewczyk,
  • Łukasz Tułecki,
  • Andrzej Kleinrok,
  • Andrzej Kutarski
Dorota Nowosielecka
The Pope John Paul II Province Hospital
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Wojciech Jacheć
Medical University of Silesia in Katowice, Faculty of Medical Sciences in Zabrze
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Anna Polewczyk
Collegium Medicum of The Jan Kochanowski University
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Łukasz Tułecki
The Pope John Paul II Province Hospital
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Andrzej Kleinrok
The Pope John Paul II Province Hospital
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Andrzej Kutarski
Medical University of Lublin
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Abstract

Introduction Transesophageal echocardiography (TEE) is a useful tool in preoperative observation of patients undergoing transvenous leads extraction (TLE) due to complications associated with implanted devices. Echocardiographic phenomena may determine the safety of the procedure. Methods and results Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. 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%), lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivatiate 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.