Abstract Body (Do not enter title and authors here): Background: Transvenous lead extraction (TLE) may be indicated for cardiac implantable electronic device infection, malfunction, or upgrade. TLE can increase right heart pressures and mobilize debris, resulting in a right-to-left embolism and stroke via a patent foramen ovale (PFO).
Aims: To identify the prevalence of PFO in patients undergoing TLE, characterize affected patients, and compare incidence of adverse events.
Hypothesis: The presence of a PFO in patients undergoing TLE will result in a higher incidence of adverse events.
Methods: Intraoperative transesophageal echocardiogram (TEE) is routinely performed during TLE at University of California, San Diego. Between 11/2021 and 12/2023, 200 patients had intraoperative TEE reports available, with Color flow Doppler being used to identify PFO. Lead-associated vegetation or thrombus was only reported on preoperative TEE. Patient characteristics and outcomes were collected and compared by PFO status.
Results: Of 200 patients with TEE reported during TLE, mean age was 65.1 with a standard deviation of ± 15.1; 64% were male. PFO was detected in 26 (13%) patients but was not associated with different baseline characteristics. Overall, mean lead count was 2.3 ± 0.7, dwell time was 4.7 ± 3.7 years, and procedural success was 95.5% with no difference by PFO status. Most common extraction indications were malfunction (44.1%) and infection (29.6%). Preoperative TEE reported lead-associated thrombus in 0/14 (0%) patients with PFO versus 7/98 (7.1%) without PFO (p>0.99) and lead-associated vegetation in 2/6 (33.3%) patients with PFO versus 12/64 (18.8%) patients without PFO (p=0.59). In-hospital stroke was not different by PFO status (1/26 3.8% PFO vs 1/174 0.6% no PFO, p=0.24) and no patients experienced myocardial infarction. In-hospital mortality was significantly higher in patients with PFO (2/26 7.7% PFO vs 0/174 0% no PFO, p=0.016). Of these two deaths in the PFO cohort, one was due to stroke-related complications and the other to sepsis.
Conclusion: PFO was detected in 13% of patients on intraoperative TEE during TLE. Stroke incidence was similar by PFO status, but mortality was higher in those with PFO. Further studies are needed to understand this association.