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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)253-261
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume51
Issue number3
DOIs
Publication statusPublished - Apr 1 2018

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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