Seung-Jung Park1, James L Gentry2, Niraj Varma2, Oussama Wazni2, Khaldoun G Tarakji2, Anand Mehta3, Stephanie Mick4, Richard Grimm2, Bruce L Wilkoff5. 1. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio; Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 3. Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio. 4. Department of and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio. 5. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: wilkofb@ccf.org.
Abstract
OBJECTIVES: The aims of this study were to detect and quantify acute increases in tricuspid regurgitation (TR) severity following transvenous lead extraction (TLE) and to evaluate the associated risk factors. BACKGROUND: Although established as a safe and effective method for lead removal, TLE is sometimes complicated by TR. METHODS: In 208 consecutive patients undergoing TLE, acute changes in TR severity were assessed by transesophageal echocardiography. A significant acute TR increase (TRI) was defined as a ≥1 grade increase in TR severity and post-extraction TR severity that was moderate or greater. RESULTS: Overall, 266 ventricular leads (mean lead age, 11.8 ± 7.3 years) were extracted from the 208 patients. A significant acute TRI was observed in 24 (11.5%) of these patients. Acute TRI was associated with longer lead implant duration, extraction of pacemaker rather than defibrillator leads, anatomic injury to the tricuspid valve (TV), and longer post-extraction hospital stays. Multivariate analysis yielded only lead implant duration as an independent predictor of TLE-related acute TRI (odds ratio: 1.05; 95% confidence interval: 1.01 to 1.11; p = 0.046). When the patients were divided into 4 subgroups according to quartiles of lead age, there was a graded elevation in the rates of acute TRI (p trend = 0.048) and TV injury (p trend = 0.009) with lead implant duration. CONCLUSIONS: Following TLE, TV damage and acute TRI were commonly detected by transesophageal echocardiography, particularly in patients with advanced lead age. Lead abandonment strategies, which prolong implantation duration of future leads requiring extraction, should consider the potential long-term deleterious impact on TV function.
OBJECTIVES: The aims of this study were to detect and quantify acute increases in tricuspid regurgitation (TR) severity following transvenous lead extraction (TLE) and to evaluate the associated risk factors. BACKGROUND: Although established as a safe and effective method for lead removal, TLE is sometimes complicated by TR. METHODS: In 208 consecutive patients undergoing TLE, acute changes in TR severity were assessed by transesophageal echocardiography. A significant acute TR increase (TRI) was defined as a ≥1 grade increase in TR severity and post-extraction TR severity that was moderate or greater. RESULTS: Overall, 266 ventricular leads (mean lead age, 11.8 ± 7.3 years) were extracted from the 208 patients. A significant acute TRI was observed in 24 (11.5%) of these patients. Acute TRI was associated with longer lead implant duration, extraction of pacemaker rather than defibrillator leads, anatomic injury to the tricuspid valve (TV), and longer post-extraction hospital stays. Multivariate analysis yielded only lead implant duration as an independent predictor of TLE-related acute TRI (odds ratio: 1.05; 95% confidence interval: 1.01 to 1.11; p = 0.046). When the patients were divided into 4 subgroups according to quartiles of lead age, there was a graded elevation in the rates of acute TRI (p trend = 0.048) and TV injury (p trend = 0.009) with lead implant duration. CONCLUSIONS: Following TLE, TV damage and acute TRI were commonly detected by transesophageal echocardiography, particularly in patients with advanced lead age. Lead abandonment strategies, which prolong implantation duration of future leads requiring extraction, should consider the potential long-term deleterious impact on TV function.
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Andrzej Kleinrok; Łukasz Tułecki; Andrzej Kutarski Journal: Cardiovasc Diagn Ther Date: 2021-04
Authors: Mihai Strachinaru; Chris M Kievit; Sing C Yap; Alexander Hirsch; Marcel L Geleijnse; Tamas Szili-Torok Journal: Echocardiography Date: 2019-03-24 Impact factor: 1.724
Authors: Łukasz Tułecki; Anna Polewczyk; Wojciech Jacheć; Dorota Nowosielecka; Konrad Tomków; Paweł Stefańczyk; Jarosław Kosior; Krzysztof Duda; Maciej Polewczyk; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2021-08-28 Impact factor: 3.390
Authors: Elhosseyn Guella; Frances Devereux; Fozia Zahir Ahmed; Peter Scott; Colin Cunnington; Amir Zaidi Journal: Eur Heart J Case Rep Date: 2021-07-19
Authors: Anna Polewczyk; Wojciech Jacheć; Dorota Nowosielecka; Andrzej Tomaszewski; Wojciech Brzozowski; Dorota Szczęśniak-Stańczyk; Krzysztof Duda; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2022-09-27 Impact factor: 4.614
Authors: Felix Hedwig; Olena Nemchyna; Julia Stein; Christoph Knosalla; Nicolas Merke; Fabian Knebel; Andreas Hagendorff; Felix Schoenrath; Volkmar Falk; Jan Knierim Journal: Front Cardiovasc Med Date: 2021-06-18