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Endocardial lead extraction with transoesophageal echocardiography guidance for cardiovascular implantable electronic device (CIED) related infections: four cases report


 Background

With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. The recommended treatment of which involves the complete removal of all hardware, followed by antibiotic therapy and re-implant. Application of transoesophageal echocardiography (TEE) helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications.
Case presentation

: We report four cases of CIED infections from single-centre, who were extracted endocardial leads with intra-op TEE monitoring and guidance. Three of them had three fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op TTE, which avoided intra-op embolism.
Conclusions

Continuously intra-op TEE should be one of the routine monitoring methods in these high-risk endocardial leads extraction procedures.