The impact of transvenous lead extraction on tricuspid valve function

James O. Coffey, Solomon J. Sager, Sandeep Gangireddy, Avi Levine, Juan Viles Gonzalez, Avi Fischer

Research output: Contribution to journalArticle

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Abstract

Background Few data exist regarding the effect of transvenous lead extraction (TLE) on tricuspid valve function. The objective of this study was to examine the effect of TLE on the development of postprocedure tricuspid regurgitation (TR). Objective To assess the impact of TLE on tricuspid valve function. Methods A single center retrospective analysis of consecutive patients referred for TLE between June 2006 and November 2011. Patients were included only if they underwent transthoracic echocardiography (TTE) before and after lead extraction (N = 124). Patients were assigned a preprocedure and postprocedure TR score on a continuous scale from 0 to 6 (0 = none, 1 = trace, 2 = mild, 3 = mild/moderate, 4 = moderate, 5 = moderate/severe, and 6 = severe). A clinically significant increase in TR was defined as both (1) an increase in TR score of at least two points, and (2) a postprocedure TR score ≥4 (moderate). Results A total of 124 patients referred for TLE underwent a TTE both before (9 ±16 months) and after lead extraction (4 ± 8 months). A total of 200 leads (1.6 ± 0.8 per patient) were extracted. The mean change in TR score after lead extraction was +0.18 (95% confidence interval [CI] -0.03 to 0.39, P = 0.11). A clinically significant increase in TR occurred in 7/124 (5.6% [CI 2.3-11.3%]) patients. Age ≥75 (+0.45, [CI 0.07-0.84, P = 0.02]), removal of ≥2 leads (+0.40 [CI 0-0.81, P = 0.05]), and powered sheath-assisted extraction (+0.34 [CI 0.05-0.62, P = 0.02]) were significantly associated with an increase in TR score. Conclusion TLE is rarely associated with the development of clinically significant TR. In our cohort, patient age ≥75 years, pacemaker as opposed to ICD, and removal of ≥2 leads predicted worsening TR.

Original languageEnglish
Pages (from-to)19-24
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2014

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Tricuspid Valve Insufficiency
Tricuspid Valve
Confidence Intervals
Echocardiography
Lead

Keywords

  • cardiac implantable electronic device
  • device infection
  • device malfunction
  • lead extraction
  • tricuspid regurgitation
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coffey, J. O., Sager, S. J., Gangireddy, S., Levine, A., Viles Gonzalez, J., & Fischer, A. (2014). The impact of transvenous lead extraction on tricuspid valve function. PACE - Pacing and Clinical Electrophysiology, 37(1), 19-24. https://doi.org/10.1111/pace.12236

The impact of transvenous lead extraction on tricuspid valve function. / Coffey, James O.; Sager, Solomon J.; Gangireddy, Sandeep; Levine, Avi; Viles Gonzalez, Juan; Fischer, Avi.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 37, No. 1, 01.01.2014, p. 19-24.

Research output: Contribution to journalArticle

Coffey, JO, Sager, SJ, Gangireddy, S, Levine, A, Viles Gonzalez, J & Fischer, A 2014, 'The impact of transvenous lead extraction on tricuspid valve function', PACE - Pacing and Clinical Electrophysiology, vol. 37, no. 1, pp. 19-24. https://doi.org/10.1111/pace.12236
Coffey JO, Sager SJ, Gangireddy S, Levine A, Viles Gonzalez J, Fischer A. The impact of transvenous lead extraction on tricuspid valve function. PACE - Pacing and Clinical Electrophysiology. 2014 Jan 1;37(1):19-24. https://doi.org/10.1111/pace.12236
Coffey, James O. ; Sager, Solomon J. ; Gangireddy, Sandeep ; Levine, Avi ; Viles Gonzalez, Juan ; Fischer, Avi. / The impact of transvenous lead extraction on tricuspid valve function. In: PACE - Pacing and Clinical Electrophysiology. 2014 ; Vol. 37, No. 1. pp. 19-24.
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abstract = "Background Few data exist regarding the effect of transvenous lead extraction (TLE) on tricuspid valve function. The objective of this study was to examine the effect of TLE on the development of postprocedure tricuspid regurgitation (TR). Objective To assess the impact of TLE on tricuspid valve function. Methods A single center retrospective analysis of consecutive patients referred for TLE between June 2006 and November 2011. Patients were included only if they underwent transthoracic echocardiography (TTE) before and after lead extraction (N = 124). Patients were assigned a preprocedure and postprocedure TR score on a continuous scale from 0 to 6 (0 = none, 1 = trace, 2 = mild, 3 = mild/moderate, 4 = moderate, 5 = moderate/severe, and 6 = severe). A clinically significant increase in TR was defined as both (1) an increase in TR score of at least two points, and (2) a postprocedure TR score ≥4 (moderate). Results A total of 124 patients referred for TLE underwent a TTE both before (9 ±16 months) and after lead extraction (4 ± 8 months). A total of 200 leads (1.6 ± 0.8 per patient) were extracted. The mean change in TR score after lead extraction was +0.18 (95{\%} confidence interval [CI] -0.03 to 0.39, P = 0.11). A clinically significant increase in TR occurred in 7/124 (5.6{\%} [CI 2.3-11.3{\%}]) patients. Age ≥75 (+0.45, [CI 0.07-0.84, P = 0.02]), removal of ≥2 leads (+0.40 [CI 0-0.81, P = 0.05]), and powered sheath-assisted extraction (+0.34 [CI 0.05-0.62, P = 0.02]) were significantly associated with an increase in TR score. Conclusion TLE is rarely associated with the development of clinically significant TR. In our cohort, patient age ≥75 years, pacemaker as opposed to ICD, and removal of ≥2 leads predicted worsening TR.",
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AU - Coffey, James O.

AU - Sager, Solomon J.

AU - Gangireddy, Sandeep

AU - Levine, Avi

AU - Viles Gonzalez, Juan

AU - Fischer, Avi

PY - 2014/1/1

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N2 - Background Few data exist regarding the effect of transvenous lead extraction (TLE) on tricuspid valve function. The objective of this study was to examine the effect of TLE on the development of postprocedure tricuspid regurgitation (TR). Objective To assess the impact of TLE on tricuspid valve function. Methods A single center retrospective analysis of consecutive patients referred for TLE between June 2006 and November 2011. Patients were included only if they underwent transthoracic echocardiography (TTE) before and after lead extraction (N = 124). Patients were assigned a preprocedure and postprocedure TR score on a continuous scale from 0 to 6 (0 = none, 1 = trace, 2 = mild, 3 = mild/moderate, 4 = moderate, 5 = moderate/severe, and 6 = severe). A clinically significant increase in TR was defined as both (1) an increase in TR score of at least two points, and (2) a postprocedure TR score ≥4 (moderate). Results A total of 124 patients referred for TLE underwent a TTE both before (9 ±16 months) and after lead extraction (4 ± 8 months). A total of 200 leads (1.6 ± 0.8 per patient) were extracted. The mean change in TR score after lead extraction was +0.18 (95% confidence interval [CI] -0.03 to 0.39, P = 0.11). A clinically significant increase in TR occurred in 7/124 (5.6% [CI 2.3-11.3%]) patients. Age ≥75 (+0.45, [CI 0.07-0.84, P = 0.02]), removal of ≥2 leads (+0.40 [CI 0-0.81, P = 0.05]), and powered sheath-assisted extraction (+0.34 [CI 0.05-0.62, P = 0.02]) were significantly associated with an increase in TR score. Conclusion TLE is rarely associated with the development of clinically significant TR. In our cohort, patient age ≥75 years, pacemaker as opposed to ICD, and removal of ≥2 leads predicted worsening TR.

AB - Background Few data exist regarding the effect of transvenous lead extraction (TLE) on tricuspid valve function. The objective of this study was to examine the effect of TLE on the development of postprocedure tricuspid regurgitation (TR). Objective To assess the impact of TLE on tricuspid valve function. Methods A single center retrospective analysis of consecutive patients referred for TLE between June 2006 and November 2011. Patients were included only if they underwent transthoracic echocardiography (TTE) before and after lead extraction (N = 124). Patients were assigned a preprocedure and postprocedure TR score on a continuous scale from 0 to 6 (0 = none, 1 = trace, 2 = mild, 3 = mild/moderate, 4 = moderate, 5 = moderate/severe, and 6 = severe). A clinically significant increase in TR was defined as both (1) an increase in TR score of at least two points, and (2) a postprocedure TR score ≥4 (moderate). Results A total of 124 patients referred for TLE underwent a TTE both before (9 ±16 months) and after lead extraction (4 ± 8 months). A total of 200 leads (1.6 ± 0.8 per patient) were extracted. The mean change in TR score after lead extraction was +0.18 (95% confidence interval [CI] -0.03 to 0.39, P = 0.11). A clinically significant increase in TR occurred in 7/124 (5.6% [CI 2.3-11.3%]) patients. Age ≥75 (+0.45, [CI 0.07-0.84, P = 0.02]), removal of ≥2 leads (+0.40 [CI 0-0.81, P = 0.05]), and powered sheath-assisted extraction (+0.34 [CI 0.05-0.62, P = 0.02]) were significantly associated with an increase in TR score. Conclusion TLE is rarely associated with the development of clinically significant TR. In our cohort, patient age ≥75 years, pacemaker as opposed to ICD, and removal of ≥2 leads predicted worsening TR.

KW - cardiac implantable electronic device

KW - device infection

KW - device malfunction

KW - lead extraction

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KW - valvular heart disease

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