Transesophageal echocardiography for the monitoring of transvenous lead extraction

Abstract

Transesophageal echocardiography (TEE) is regarded as the gold standard in diagnostic cardiology and has become an essential tool for monitoring the patient undergoing cardiac surgery and transcatheter procedures. Considering the increasing number of complications related to cardiac implantable electronic devices, TEE can also be used to detect these irregularities. Transvenous lead extraction (TLE) is the first­­line treatment for cardiac implantable electronic device–related complications. The essence of TLE is the dissection of leads from connective tissue adhesions that attach them to the walls of the heart and vessels. Separation of strongly immobilized leads may cause injury to the veins or heart resulting in life­­threatening bleeding. For this reason, the guidelines from the American and European cardiac societies recommend clinicians to use TEE for monitoring the patient undergoing TLE. The advantage of such an approach is immediate detection, localization, and evaluation of TLE complications and sequelae. Additionally, according to our experience, continuous monitoring of the TLE procedure enables the operator to be informed about the expected technical problems.