Transesophageal Echocardiography as a Monitoring Tool during Transvenous Lead Extraction-Does It Improve Procedure Effectiveness?

Background: Transesophageal echocardiography (TEE) is a valuable tool for monitoring the patient during transvenous lead extraction (TLE), but the direct impact of TEE on the effectiveness and safety of TLE has not yet been documented. Methods: The effectiveness of TLE and short-term survival were compared between two groups of patients: 2106 patients in whom TEE was performed before and after TLE and 1079 individuals in whom continuous TEE monitoring was used. The procedure-related risk of major complications was assessed using a predictive SAFeTY TLE score. Results: The patients monitored by TEE were characterized by older age, more comorbidities and higher SAFeTY TLE scores (6.143 +/- 4.395 vs. 5.593 +/- 4.127; p = 0.004). Complete procedural success was significantly higher in the TEE-guided group (97.683% vs. 95.442%, p < 0.01). The rate of serious complications in the TEE-guided group was lower than the predictive SAFeTY TLE score-a reduction of 28.75% (p < 0.05). Periprocedural mortality in the TEE-guided and non-TEE-guided groups was zero vs. six deaths (p = 0.186). Short-term survival was comparable between the groups. Conclusions: Transesophageal echocardiography as a monitoring tool during transvenous lead extraction provides valuable results-higher rates of complete procedural success and a reduced risk of the most severe complications, thus preventing periprocedural deaths.