Henrikson Charles A, Zhang Karl, Brinker Jeffrey A
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Pacing Clin Electrophysiol. 2010 Jun 1;33(6):721-6. doi: 10.1111/j.1540-8159.2010.02692.x. Epub 2010 Feb 1.
Endovascular lead extraction is an important component of the management of patients with chronically implanted arrhythmia control devices. Although it is associated with the potential for significant morbidity and mortality, there is little information about its scope and practice.
We surveyed 1,000 physician members of the Heart Rhythm Society via e-mail solicitation.
Of the 252 respondents (25%), 221 (88%) reported either performing extractions themselves (63%), or having privileges at a hospital where extractions are performed (25%). Electrophysiologists perform extractions at most sites (83%) but cardiac surgeons perform endovascular lead extraction at a significant minority of sites (20%). Most respondents report low annual volumes of extractions at their site: 15% reported <10 procedures/year, 42% 10-25 procedures/year, 23% 26-50 procedure/year, and only 19% reported >50 procedures/year. Thirty-six percent of respondents reported that extractions were done in the operating room (OR) with surgeon present or immediately available, 39% in the electrophysiology (EP) lab with surgeon and OR identified and available, and 25% in EP lab without a surgeon or OR identified. The overall risks of lead extraction were felt to be 1-5% of major complication and 0.5-1% of mortality, roughly in line with published data.
While there is agreement as to the risk of major complication and death from lead extraction, the degree of surgical availability varies considerably. The new guidelines document recommends the ability to promptly initiate an emergent surgical procedure, and this should be an important goal for all extractionists.
血管内导线拔除术是慢性植入心律失常控制装置患者管理的重要组成部分。尽管该手术存在显著的发病和死亡风险，但关于其范围和实践的信息却很少。
我们通过电子邮件邀请对1000名心律协会的医生会员进行了调查。
在252名受访者（25%）中，221名（88%）报告称自己要么亲自进行导线拔除（63%），要么在进行导线拔除的医院拥有相关权限（25%）。大多数部位的导线拔除由电生理学家进行（83%），但心脏外科医生在少数部位进行血管内导线拔除（20%）。大多数受访者报告其所在部位每年的导线拔除量较低：15%报告每年手术量<10例，42%报告每年手术量为10 - 25例，23%报告每年手术量为26 - 50例，只有19%报告每年手术量>50例。36%的受访者报告导线拔除在手术室（OR）进行，有外科医生在场或随时可到场；39%在电生理（EP）实验室进行，有外科医生且手术室已确定并可随时使用；25%在EP实验室进行，无外科医生或未确定手术室。导线拔除的总体风险被认为主要并发症发生率为1 - 5%，死亡率为0.5 - 1%，大致与已发表的数据一致。
虽然对于导线拔除导致的主要并发症和死亡风险存在共识，但手术支持的程度差异很大。新的指南文件建议具备迅速启动紧急手术的能力，这应该是所有导线拔除操作者的重要目标。
