Jones Samuel O, Eckart Robert E, Albert Christine M, Epstein Laurence M
Arrhythmia Service, Department of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Heart Rhythm. 2008 Apr;5(4):520-5. doi: 10.1016/j.hrthm.2008.01.009. Epub 2008 Jan 17.
Lead extraction is increasingly necessary given the exponential growth in cardiac device implantation. Meanwhile, the tools, indications, and outcomes of this procedure continue to change.
The purpose of this study was to examine contemporary indications, outcomes, and complications of transvenous lead extraction in a large series of patients at a high-volume lead extraction center.
We performed a retrospective cohort study of consecutive patients undergoing lead extraction at a single, high-volume center. Patient and lead characteristics and the indications, outcomes, and need for laser assistance were analyzed.
From January 2000 to March 2007, a total of 975 chronic endovascular leads were removed from 498 patients. Median implant duration was 5.7 years (range 0.5-32.7 years). Indications were infection (60.3%), mechanical lead failure (29.3%), and upgrade of device system (8.8%). Over the study period, lead malfunction decreased relative to other indications. Laser assistance for extraction was more likely with leads implanted longer than 3.4 years compared to less than 3.4 years (odds ratio 6.15, 95% confidence interval 3.35-11.28) and with implantable cardioverter-defibrillator leads compared to pacemaker leads (odds ratio 3.44, 95% confidence interval 1.84-6.43). Overall, 97.5% of the leads were completely removed. Major complications occurred in 2 (0.4%) patients. Only one patient required cardiac surgery. No deaths occurred.
In a high-volume center, lead extraction has a high success rate and low complication rate. Infection was the most common indication overall. Lead failure has decreased in relative proportion. Implantable cardioverter-defibrillator leads and longer lead implant time are associated with a requirement for laser lead extraction.
鉴于心脏设备植入数量呈指数增长，导线拔除变得越来越必要。与此同时，该手术的工具、适应症和结果也在不断变化。
本研究的目的是在一个高容量导线拔除中心，对大量患者进行经静脉导线拔除的当代适应症、结果和并发症进行研究。
我们对在一个单一的高容量中心连续接受导线拔除的患者进行了回顾性队列研究。分析了患者和导线的特征以及适应症、结果和激光辅助的需求。
从2000年1月至2007年3月，共从498例患者中拔除了975根慢性血管内导线。植入的中位持续时间为5.7年（范围0.5 - 32.7年）。适应症包括感染（60.3%）、机械性导线故障（29.3%）和设备系统升级（8.8%）。在研究期间，与其他适应症相比，导线故障有所减少。与植入时间少于3.4年的导线相比，植入时间超过3.4年的导线更有可能需要激光辅助拔除（优势比6.15，95%置信区间3.35 - 11.28），与起搏器导线相比，植入式心律转复除颤器导线更有可能需要激光辅助拔除（优势比3.44，95%置信区间1.84 - 6.43）。总体而言，97.5%的导线被完全拔除。2例（0.4%）患者发生了主要并发症。仅1例患者需要心脏手术。无死亡病例。
在高容量中心，导线拔除成功率高且并发症发生率低。感染是总体上最常见的适应症。导线故障的相对比例有所下降。植入式心律转复除颤器导线和较长的导线植入时间与激光导线拔除的需求相关。
