P336Transesophageal echocardiography in the diagnosis of lost silicone tubes after transvenous lead extraction.

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Purpose: Lead breakage is known but serious complication of transvenous lead extraction (TLE). This study stress the role of transesophageal echocardiography (TEE) in detection and management of this rare complication of TLE.Methods: TLE procedures were performed in 758 patients, aged 5-91y. (av. 64.7±16.9y.). The TLE intervensions were accomplished with the use of mechanical system of telescopic polypropylene Cook`s and Byrd dilators. The TEE was done routinely before and after TLE.Results: The analysis included 758 TLE procedures with 1113 lead extraction. In this group we found 37 lead breakage in 35 patients. In 32 patients the following TLE intervension managed to remove the broken leads with use of basket or lasso catheters. Only 3 patients were scheduled for planned cardiac surgery. During broken lead extraction the external lead silicone tube was lost in 7 patients. The broken internal metal conductor was removed transvenously but the silicone tube remained in the heart cavities. The lack of silicone tube was discovered intraoperatively (n=4) and confirmed by TEE. In 3 patients it was diagnosed by TEE only. In TEE silicone tube has lead appearance but different movement (elastic and gentle in the contrary to the rigid lead). Despite impossibility of X-ray visualization silicone tubes were removed transvenously in all 7 patients via jugular or femoral approach.Conclusions: 1. TEE is the excellent method in the diagnosis and management of lost silicone tubes after TLE.2. Lead breakage appears in 4.6% among TLE procedures and in 3.3% among extracted leads. The remnants may be usually removed transvenously.3. Broken lead fragment extraction can be complicated by lead silicone tube loss. It may be suspected intraoperatively and confirmed by TEE. It occurs in 0.5% TLE procedures but in 20 % of lead fragment extraction intervensions.

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