Figure 1
Additional masses associated with endocardial leads detected on preprocedural TEE
  1. TEE (2D and 3D, ME- bicaval) In the RA an additional mass (red arrow) attached to the lead, a mobile mass (blue arrows) representing a bacterial vegetation
  2. TEE (2D and 3 D, ME- bicaval) Segmental lead thickening (red arrow) in the atrial course with an additional mobile mass (blue arrow) representing the connective tissue build-up (accretion, scar)
  3. TEE (2D, ME- modified) In the RA cavity close to the SVC orifice an echo of two leads (red arrows) with additional irregular masses (green arrows) at lead-to-lead binding site (yellow arrow) representing clots. C1 – 3D imaging
  4. TEE (2D, ME- modified to visualize right cardiac chambers) In the RA a mass attached to the lead (red arrow) that may represent a pseudo vegetation (blue arrow)
Visualization of excess lead loops was another component of the TEE evaluation of patients before TLE. Lead looping was usually a result of long-term contact with the myocardium, and hence a stronger adhesion involving longer segments. In this study excess lead loops were most common in the RA (138; 14.744% cases), and least frequent in the RV and the TPA (35; 3.793% cases). The presence of excess lead loops did not affect the procedure-related risk, although it increased the level of complexity.
Lead loops are very well visible on fluoroscopy, but the advantage of TEE is that it permits detection of fibrous tissue binding the lead loops to the heart walls and its possible impact on the tricuspid apparatus (Figure 2).