Author + information
- Received May 22, 2018
- Revision received July 16, 2018
- Accepted July 17, 2018
- Published online November 19, 2018.
- Seung-Jung Park, MD, PhDa,b,
- James L. Gentry III, MDa,
- Niraj Varma, MD, PhDa,
- Oussama Wazni, MDa,
- Khaldoun G. Tarakji, MD, MPHa,
- Anand Mehta, MDc,
- Stephanie Mick, MDd,
- Richard Grimm, DOa and
- Bruce L. Wilkoff, MDa,∗ ()
- aDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- cDepartment of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- dDepartment of and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Bruce L. Wilkoff, Department of Cardiovascular Medicine, Desk J2-2, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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.
Dr. Tarakji has been on the medical advisory boards of Medtronic and AliveCor. Dr. Wilkoff has been a consultant for Medtronic, Abbott, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 22, 2018.
- Revision received July 16, 2018.
- Accepted July 17, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.