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

  • François Regoli
  • Gabriele D’Ambrosio
  • Maria Luce Caputo
  • Stefano Svab
  • Giulio Conte
  • Tiziano Moccetti
  • Catherine Klersy
  • Tiziano Cassina
  • Stefanos Demertzis
  • Angelo Auricchio
Article

Abstract

Purpose

Pericardial effusion (PE) may occur during the lead extraction procedure (TLE). Little is known about the incidence, causes, and predictors of this complication.

Methods

From 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

Clinical 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.

Keywords

Lead extraction complications Pericardial effusion during lead extraction Superior vena cava tear during lead extraction Lead extraction complication management 

Notes

Compliance with ethical standards

Conflicts of interest

Dr. F. Regoli receives speaker fees from Abbott (former St. Jude Medical), Boston Scientific, Bayer; Dr. A. Auricchio is a consultant for Medtronic, LivaNova, and Boston Scientific.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • François Regoli
    • 1
  • Gabriele D’Ambrosio
    • 1
    • 2
  • Maria Luce Caputo
    • 1
  • Stefano Svab
    • 1
  • Giulio Conte
    • 1
  • Tiziano Moccetti
    • 1
  • Catherine Klersy
    • 3
  • Tiziano Cassina
    • 1
  • Stefanos Demertzis
    • 1
  • Angelo Auricchio
    • 1
  1. 1.Division of CardiologyFondazione Cardiocentro TicinoLuganoSwitzerland
  2. 2.Department of Life, Health & Environmental Sciences (MESVA)University of L’AquilaL’AquilaItaly
  3. 3.Service of Biometry and StatisticsIRCCS Fondazione Policlinico S MatteoPaviaItaly

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