Figure 1
Additional masses associated with endocardial leads detected on
preprocedural TEE
- 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
- 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)
- 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
- 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).