Mahapatra Srijoy, Homoud Munthur K, Wang Paul J, Estes N A Mark, Link Mark S
Cardiac Arrhythmia Service, Tufts University School of Medicine, New England Medical Center, Boston 02111, Massachusetts, USA.
Pacing Clin Electrophysiol. 2003 Dec;26(12):2225-9. doi: 10.1111/j.1540-8159.2003.00351.x.
Breaks in the insulation portions of implantable cardioverter defibrillator (ICD) leads may cause nonphysiological sensing and subsequent inappropriate ICD therapy, and may also interfere with the sensing and pacing functions of the ICD. Previously, leads with insulation breaks have been replaced with new sensing leads. However, repair of leads, utilizing a commercially available patch kit may reduce the morbidity, hospital stay, and cost of lead replacement. The long-term durability of these repairs has not previously been reported and is the subject of this study. Patients undergoing ICD sensing lead repair or replacement constituted the study population. Patients were followed at 3 month intervals with an endpoint of new lead abnormalities necessitating repeat lead repair or replacement. Twenty-five patients underwent lead repair and 27 individuals underwent lead replacement for either preoperative nonphysiological sensing (n = 25) or intraoperative evidence of insulation break (n = 27). There was no significant difference between the individuals undergoing lead repair or replacement in age (59 +/- 9 vs 60 +/- 12 years), mean left ventricular ejection fraction (40%+/- 18% vs 33%+/- 17%) or age of the lead being repaired or replaced (4.5 +/- 2.0 years vs 5.0 +/- 2.0 years). During follow-up of 44 +/- 23 months, 4 of the repaired leads and 4 of the replaced leads developed new insulation breaks requiring surgical intervention (P = 0.43). In conclusion, in nearly 4 years of follow-up of patients with sensing lead insulation breaks, there was no difference is subsequent lead survival in those with lead repair compared to those with new sensing leads inserted. The strategy of lead repair, when technically feasible, should thus be considered in all patients with sensing abnormalities secondary to insulation breaks.
植入式心脏复律除颤器（ICD）导线绝缘部分的破损可能会导致非生理性感知及随后不适当的ICD治疗，还可能干扰ICD的感知和起搏功能。此前，绝缘破损的导线已被新的感知导线所取代。然而，使用市售的贴片套件对导线进行修复可能会降低发病率、缩短住院时间并降低导线更换成本。此前尚未报道过这些修复的长期耐用性，本研究将对此进行探讨。接受ICD感知导线修复或更换的患者构成了研究人群。每隔3个月对患者进行随访，终点为出现新的导线异常，需要再次进行导线修复或更换。25例患者接受了导线修复，27例患者因术前非生理性感知（n = 25）或术中发现绝缘破损（n = 27）而接受了导线更换。接受导线修复或更换的患者在年龄（59±9岁 vs 60±12岁）、平均左心室射血分数（40%±18% vs 33%±17%）或被修复或更换导线的使用年限（4.5±2.0年 vs 5.0±2.0年）方面无显著差异。在44±23个月的随访期间，4根修复后的导线和4根更换后的导线出现了新的绝缘破损，需要手术干预（P = 0.43）。总之，在对感知导线绝缘破损患者进行近4年的随访中，与插入新的感知导线的患者相比，导线修复患者的后续导线存活率并无差异。因此，在技术可行的情况下，对于所有因绝缘破损继发感知异常的患者，都应考虑导线修复策略。
