136-55: Pericardial effusion during transvenous lead extraction: not always the same story

Purpose: Pericardial effusion (PE) may be a life-threatening complication of lead extraction procedure (TLE). We evaluated causative mechanism of PE formation during TLE and subsequent patient management.

Method: From January 2009 to June 2015, TLE of 264 leads in 184 patients(pts)(mean age 69 ± 14 years, 131 male, mean BMI 27 ± 11m²/kg, LVEF 43± 27%) was performed. Indications for TLE included lead dysfunction (60.4%), upgrade (18.9%), infection (13.2%), or other (6.3%). TLE was first attempted using mechanical approach, and eventually combined with laser technique. Extraction procedures were performed under general anesthesia with continuous invasive arterial blood pressure and transesophageal echocardiography (TEE) monitoring. Severity of PE was defined as mild (<10 mm), moderate (11–20 mm), or severe (≥20 mm).

Summary of Results: TLE was complete for 256 of 264 leads (97.0%). PE developed in 11 pts (6.0%): mild in 6 pts (3.3%) and severe in 5 pts (2.7%). All patients with severe PE experienced hemodynamic instability; 3 pts required urgent cardiac surgery and 2 patients were treated medically. Key differences between these patients was the site of lesion, namely RV in all patients treated in a conservative manner (fluid infusion and repeated echocardiographic examinations). Laceration of the superior vena cava (2 pts) and right atrial free wall (1 pt) resulted in rescue surgery. Pre-discharge transthoracic echocardiography excluded PE evolution in all cases and no recurrences occurred during follow-up.

Conclusion: Sudden onset of severe PE during TLE is a life-threatening condition. Evolution and subsequent pt management depends on the site of lesion, with RV site lesions being self-limiting.