Key result
Intra-operative TEE facilitates rapid recognition of severe complications during CIED lead extraction.
Why the study?
Expanding use of CIEDs in older patients with more complicated conditions has brought higher rates of CIED infections.
Does intra-operative TEE monitoring improve safety and complication management during endocardial lead extraction for CIED infections?
Case Report (n=4)
No
Does intra-operative TEE monitoring improve safety and complication management during endocardial lead extraction for CIED infections?
Continuous intra-operative TEE monitoring during high-risk CIED lead extraction can rapidly detect severe complications and guide management.
Answers are grounded in this paper and cite their sources.
May support intra-operative TEE consideration in high-risk CIED extraction; leaves open need for prospective outcome data.
With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. We report four cases of CIED infections from single-center, who were extracted endocardial leads with intra-op transesophageal echocardiography (TEE) monitoring and guidance. Three of them had fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op transthoracic echocardiogram (TTE), which could avoid intra-op embolism. Application of TEE helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Thus, continuously intra-op TEE should be one of the routine monitoring methods in this high-risk procedure.
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Han et al. (2024) conducted a case report in CIED infections (n=4). Intra-operative transesophageal echocardiography (TEE) was evaluated. Intra-operative transesophageal echocardiography during endocardial lead extraction in 4 cases of CIED infection facilitated the rapid recognition of 3 fatal complications and 1 massive vegetation.
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