Van Gelder B M, Bracke F A, Oto A, Yildirir A, Haas P C, Seger J J, Stainback R F, Botman K J, Meijer A
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Pacing Clin Electrophysiol. 2000 May;23(5):877-83. doi: 10.1111/j.1540-8159.2000.tb00858.x.
Three patients from different centers with pacemaker or ICD leads endocardially implanted in the left ventricle are described. All leads, two ventricular pacing leads and one ICD lead, were inserted through a patent foramen ovale or an atrial septum defect. The diagnosis was made 9 months, 14 months, and 16 years, respectively, after implantation. All patients had right bundle branch block configuration during ventricular pacing. Chest X ray was suggestive of a left-sided positioned lead except in the ICD patient. Diagnosis was confirmed with echocardiography in all patients. One patient with a ventricular pacing lead presented with a transient ischemic attack at 1-month postimplantation. During surgical repair of the atrial septum defect 14 months later, the lead was extracted and thrombus was attached to the lead despite therapy with aspirin. The other patients were asymptomatic without anticoagulation (9 months and 16 years after implant). No thrombus was present on the ICD lead at the time of the cardiac transplantation in one patient. We reviewed 27 patients with permanent leads described in the literature. Ten patients experienced thromboembolic complications, including three of ten patients on antiplatelet therapy. The lead was removed in six patients, anticoagulation with warfarin was effective for secondary prevention in the four remaining patients. In the asymptomatic patients, the lead was removed in five patients. In the remaining patients, 1 patient was on warfarin, 2 were on antiplatelet therapy, and in 3 patients the medication was unknown. After malposition was diagnosed, three additional patients were treated with warfarin. In conclusion, if timely removal of a malpositioned lead in the left ventricle is not preformed, lifelong anticoagulation with warfarin can be recommended as the first choice therapy and lead extraction reserved in case of failure or during concomitant surgery.
本文描述了来自不同中心的3例患者，他们的起搏器或植入式心律转复除颤器（ICD）导线经心内膜植入左心室。所有导线，包括两根心室起搏导线和一根ICD导线，均通过卵圆孔未闭或房间隔缺损插入。诊断分别在植入后9个月、14个月和16年做出。所有患者在心室起搏时均表现为右束支阻滞图形。除ICD患者外，胸部X线提示导线位于左侧。所有患者均经超声心动图确诊。1例植入心室起搏导线的患者在植入后1个月出现短暂性脑缺血发作。14个月后在房间隔缺损手术修复期间，尽管给予阿司匹林治疗，导线仍被取出，且导线附着有血栓。其他患者无症状，未进行抗凝治疗（植入后9个月和16年）。1例患者在心脏移植时ICD导线上未发现血栓。我们回顾了文献中描述的27例植入永久性导线的患者。10例患者发生血栓栓塞并发症，其中接受抗血小板治疗的10例患者中有3例。6例患者的导线被取出，其余4例患者使用华法林抗凝进行二级预防有效。在无症状患者中，5例患者的导线被取出。其余患者中，1例使用华法林，2例使用抗血小板治疗，3例患者的用药情况不明。在诊断导线位置异常后，另外3例患者接受了华法林治疗。总之，如果不及时取出左心室位置异常的导线，可推荐终身使用华法林抗凝作为首选治疗方法，导线取出可保留用于治疗失败或同时进行手术时。
