St Ann University Hospital, Masaryk University, Pekarska 53, Brno 65691, Czech Republic.
Europace. 2009 Nov;11(11):1510-6. doi: 10.1093/europace/eup216. Epub 2009 Aug 14.
To evaluate intracardiac findings near leads and causes of death in pacemaker/defibrillator patients.
Special autopsy was performed on 78 patients deceased in a hospital. Age at death was 77.9 +/- 10.0, implantation-death interval 4.0 +/- 3.3 years, ventricular leads n = 78, and atrial leads n = 21. Thrombi along leads in brachiocephalic vein/upper caval vein (BV/UCV) were found in 22 (7), in right atrium (RA) in 11 (8), and in right ventricle (RV) in 11 cases. Bipolar lead rings were fixed by fibrous tissue in 43 (4) cases. Connective tissue bridges and tunnels were found in BV/UCV in 44 (13), in RA in 17 (15), and in RV in 68 cases, with a length of 0.2-12.0 cm. Right ventricular leads in tricuspidal orifice were fixed by fibrous tissue in 11 and penetrating chordae in 25 cases. Main causes of death were: heart failure in 35, pulmonary embolism in 9, and myocardial infarction in 11 cases.
We have found (i) thrombi on ventricular/atrial leads in 33/48%, (ii) bipolar lead rings fixed by fibrous tissue in 68/22%, (iii) connective tissue bridges or tunnels in ventricle/atrium in 87/71%, and (iv) ventricular leads fixed to valve or penetrating chordae in 46% of patients. We do recommend caution when extracting leads.
评估起搏器/除颤器患者心脏内导联附近的发现和死亡原因。
对 78 例在医院死亡的患者进行了特殊尸检。死亡时的年龄为 77.9 +/- 10.0 岁，植入-死亡间隔为 4.0 +/- 3.3 年，心室导联 n = 78，心房导联 n = 21。在头臂静脉/上腔静脉（BV/UCV）中的导线上发现了 22 例（7 例）血栓，在右心房（RA）中有 11 例（8 例），在右心室（RV）中有 11 例。在 43 例（4 例）病例中，双极导联环被纤维组织固定。在 BV/UCV 中发现了 44 例（13 例）、RA 中有 17 例（15 例）和 RV 中有 68 例连接组织桥和隧道，长度为 0.2-12.0 厘米。在三尖瓣口的右心室导联被纤维组织固定在 11 例和穿透腱索在 25 例。主要死亡原因是：心力衰竭 35 例，肺栓塞 9 例，心肌梗死 11 例。
我们发现（i）33/48%的心室/心房导联上有血栓，（ii）68/22%的双极导联环被纤维组织固定，（iii）87/71%的心室/心房中有连接组织桥或隧道，以及（iv）46%的患者心室导联固定在瓣膜或穿透腱索上。我们确实建议在提取导联时要小心。
