Premium
Incidence and Significance of Pacemaker and Implantable Cardioverter‐Defibrillator Lead Masses Discovered during Transesophageal Echocardiography
Author(s) -
DOWNEY BRIAN C.,
JUSELIUS WHITNEY E.,
PANDIAN NATESA G.,
ESTES N. A. MARK,
LINK MARK S.
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03034.x
Subject(s) - medicine , endocarditis , implantable cardioverter defibrillator , lead (geology) , context (archaeology) , incidence (geometry) , cardiology , transesophageal echocardiogram , surgery , paleontology , physics , geomorphology , optics , biology , geology
Background: Pacemaker and implantable cardioverter‐defibrillator device infections are feared complications. The finding of a lead‐associated mass on transesophageal echocardiogram (TEE) raises concern for endocarditis. However, the incidence and clinical importance of lead masses is not currently known.Methods: Consecutive patients with transvenous leads undergoing TEE from July 1, 2003, to June 30, 2005, were identified and assessed for a clinical diagnosis of endocarditis. An echocardiographer blinded to clinical information reviewed all TEEs.Results: Of 177 TEEs performed on 153 patients, a visible mass on a device lead was observed in 25 (14%), including 11 TEEs showing a lead vegetation, 13 TEEs showing lead strands, and one study showing both. Seventeen patients were adjudicated to have endocarditis, of which eight had a mass seen on a lead during TEE. Thus, 72% of patients (18 of 25) with a lead‐associated mass did not have evidence of an infection. In TEEs performed for indications other than to rule out endocarditis, lead masses were seen in 13 of 136 studies (10%), with only one patient adjudicated to clinically have an infected device.Conclusion: During this 2‐year study of consecutive patients with a tranvenous lead undergoing TEE, lead‐associated masses were found in 14% of patients. In 72% of patients, the mass did not prove to be secondary to infectious causes. Thus, masses attached to a device lead should be interpreted in the overall clinical context and, in the absence of concomitant evidence of endocarditis, should not mandate device and lead removal. (PACE 2011; 679–683)