Author + information
- Gordon Ho, MDa,∗∗ (, )
- Prerana Bhatia, MDa,∗,
- Ishan Mehta, BSa,
- Timothy Maus, MDb,
- Swapnil Khoche, MDb,
- Travis Pollema, DOc,
- Victor Gert Pretorius, MBChBc and
- Ulrika Birgersdotter-Green, MDa
- aDepartment of Medicine, Division of Cardiac Electrophysiology, University of California, San Diego, La Jolla, California
- bDepartment of Anesthesiology, University of California, San Diego, La Jolla, California
- cDepartment of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
- ↵∗Address for correspondence:
Dr. Gordon Ho, Department of Medicine, Division of Cardiac Electrophysiology, University of California, San Diego, 3350 La Jolla Village Drive, 111A, San Diego, California 92161.
Objectives This study sought to prospectively evaluate the prevalence, risk factors, and short-term major clinical outcomes of mobile thrombus detected on transvenous leads in patients undergoing lead extraction.
Background The prevalence and clinical significance of thrombus on transvenous leads in patients undergoing lead extraction is not well characterized.
Methods Consecutive patients undergoing transvenous lead extraction for noninfectious indications were enrolled. Preoperative transesophageal echocardiograms were performed prospectively for all patients to examine for mobile thrombus. Anticoagulation was not started for thrombus unless other indications were present. Clinical endpoints of mortality and cardiovascular morbidity (symptomatic pulmonary embolism, myocardial infarction, or cerebrovascular accident) were assessed at a minimum of 2-month follow-up.
Results A total of 108 patients underwent lead extraction for noninfectious indications. Lead thrombi were detected in 20 (18.5%) patients and all were <2 cm. Clinical and lead characteristics were not associated with formation of lead thrombi, except for younger patient age. In patients with detected thrombi, there were no short-term deaths, symptomatic pulmonary embolisms, or myocardial infarctions, except 1 patient with a stroke 3 months after lead extraction (7% vs. 5%; p = 1.00). Median follow-up was 9 months.
Conclusions Mobile thrombi on transvenous leads are commonly found in patients referred for transvenous lead extraction and are rarely associated with acute major adverse outcomes. Careful extraction of leads with small incidentally detected thrombi can likely be performed without major acute clinical sequelae. Larger studies with longer follow-up are needed to further assess the long-term clinical significance of lead thrombi.
- cardiac implantable devices
- transesophageal echocardiography
- transvenous lead extraction
↵∗ Drs. Ho and Bhatia contributed equally to this paper and are joint first authors.
Dr. Ho has received fellowship support from Abbott, Boston Scientific, Biotronik, and Medtronic; and owns equity in Vektor Inc. for work unrelated to this manuscript. 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 August 24, 2018.
- Revision received January 10, 2019.
- Accepted January 11, 2019.
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