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New-onset pericardial effusion during transvenous lead extraction: incidence, causative mechanisms, and associated factors


Regoli, François; D'Ambrosio, Gabriele; Caputo, Maria Luce; Svab, Stefano; Conte, Giulio; Moccetti, Tiziano; Klersy, Catherine; Cassina, Tiziano; Demertzis, Stefanos; Auricchio, Angelo (2018). New-onset pericardial effusion during transvenous lead extraction: incidence, causative mechanisms, and associated factors. Journal of Interventional Cardiac Electrophysiology, 51(3):253-261.

Abstract

PURPOSE ericardial effusion (PE) may occur during the lead extraction procedure (TLE). Little is known about the incidence, causes, and predictors of this complication.
METHODS rom January 2009 to October 2016, TLE was attempted for 297 leads in 212 patients (age 69.3 ± 12.9 years, 169 male, BMI 27.2 ± 9.9 m²/kg, LVEF 43.4 ± 24.6%) for lead dysfunction (62.7%), upgrade (16.0%), infection (14.2%), or other (7.0%) indications. TLE was performed under general anesthesia with continuous invasive arterial blood pressure and transesophageal echocardiography (TEE) monitoring. For lead removal, the mechanical approach was first attempted, followed by the laser-assisted technique when needed. Severity of PE was defined by the presence of hemodynamically significant PE > 10 mm at TEE.
RESULTS linical success was achieved for 292 leads (98.3%). New-onset PE was observed in 14 patients (6.6%) [mild entity in 7 patients (3.3%) and severe in 7 (3.3%)]. In these latter patients, intra-procedural management included surgery (n = 3), pericardiocentesis (n = 2), or a conservative approach (n = 2). Right ventricular (RV) site lesions were treated with a simple fluid infusion. Laceration of the superior vena cava and other vessels resulted in rescue surgery. Lesions of the right atrial free wall (n = 1) and coronary sinus (n = 1) were treated with pericardiocentesis. NYHA III/IV, LVEF < 35%, renal impairment, right-sided implant, and ≥2 leads targeted for TLE were associated with new-onset PE. More than two factors identified a higher risk group (16.2%, 95% CI 6.2-32.0%, P = 0.02).
CONCLUSIONS New-onset PE is common during TLE and is associated with specific factors. PE severity and subsequent patient management depend on the site of injury.

Abstract

PURPOSE ericardial effusion (PE) may occur during the lead extraction procedure (TLE). Little is known about the incidence, causes, and predictors of this complication.
METHODS rom January 2009 to October 2016, TLE was attempted for 297 leads in 212 patients (age 69.3 ± 12.9 years, 169 male, BMI 27.2 ± 9.9 m²/kg, LVEF 43.4 ± 24.6%) for lead dysfunction (62.7%), upgrade (16.0%), infection (14.2%), or other (7.0%) indications. TLE was performed under general anesthesia with continuous invasive arterial blood pressure and transesophageal echocardiography (TEE) monitoring. For lead removal, the mechanical approach was first attempted, followed by the laser-assisted technique when needed. Severity of PE was defined by the presence of hemodynamically significant PE > 10 mm at TEE.
RESULTS linical success was achieved for 292 leads (98.3%). New-onset PE was observed in 14 patients (6.6%) [mild entity in 7 patients (3.3%) and severe in 7 (3.3%)]. In these latter patients, intra-procedural management included surgery (n = 3), pericardiocentesis (n = 2), or a conservative approach (n = 2). Right ventricular (RV) site lesions were treated with a simple fluid infusion. Laceration of the superior vena cava and other vessels resulted in rescue surgery. Lesions of the right atrial free wall (n = 1) and coronary sinus (n = 1) were treated with pericardiocentesis. NYHA III/IV, LVEF < 35%, renal impairment, right-sided implant, and ≥2 leads targeted for TLE were associated with new-onset PE. More than two factors identified a higher risk group (16.2%, 95% CI 6.2-32.0%, P = 0.02).
CONCLUSIONS New-onset PE is common during TLE and is associated with specific factors. PE severity and subsequent patient management depend on the site of injury.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:April 2018
Deposited On:18 Feb 2019 12:24
Last Modified:24 Sep 2019 23:54
Publisher:Springer
ISSN:1383-875X
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s10840-018-0327-1
PubMed ID:29476380

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