Cardiology Department, Hacettepe University Faculty of Medicine, 06100, Sıhhıye, Ankara, Turkey.
Europace. 2011 Apr;13(4):543-7. doi: 10.1093/europace/euq400. Epub 2010 Nov 17.
The growing problem with endocardial lead infections and lead malfunctions has increased the interest in percutaneous lead removal technology. In this report, we present our initial experience in percutaneous lead extraction with a novel hand-powered sheath, the Evolution mechanical dilator sheath.
During 13 months between June 2009 and July 2010, 41 leads in 23 patients were removed. All of the extracted leads were >12 months old, and indications for extraction were based on the recommendations of the Heart Rhythm Society. The leads were removed by using the Evolution mechanical dilator sheath (Cook Medical) with the rotational cutting force only, without laser or radiofrequency energy. Indications for lead removal included cardiac device infection in 7 (30.4%) cases, lead malfunction in the 15 (65.2%) cases, and lead displacement in the remaining 1 case (4.4%). In 14 (60.9%) cases, the extracted device was a pacemaker, and implantable cardioverter defibrillators (ICD) in 9 (39.1%) of them. Among 41 leads, 25 (60.9%) were right ventricular, 14 (34%) were atrial, and 2 (4.8%) were coronary sinus electrode. The median time from the preceding procedure was 74 months (25-180 months). Complete procedural success with Evolution system alone was achieved in 19 (82%) patients (35 leads). Four leads were completely removed with snaring and in two leads, partial success was achieved with a remaining ventricular tip smaller than 1.5 cm. Clinical success was 100%, and all of the patients discharged uneventfully without a major complication.
Our experience confirms that the mechanical technique with Evolution system is an effective first-line method for chronically implanted pacemaker/ICD leads. Continued investigation is required to evaluate success and complication rates in comparison with other techniques.
日益增多的心内膜导线感染和导线故障问题增加了对经皮导线移除技术的兴趣。在本报告中，我们介绍了使用新型手动护套——Evolution 机械扩张鞘在经皮导线移除方面的初步经验。
在 2009 年 6 月至 2010 年 7 月的 13 个月期间，共对 23 名患者的 41 根导线进行了移除。所有被移除的导线均已使用 12 个月以上，且移除适应证基于心律学会的建议。移除导线时仅使用 Evolution 机械扩张鞘（库克医疗）施加旋转切割力，未使用激光或射频能量。导线移除的适应证包括 7 例（30.4%）心脏装置感染、15 例（65.2%）导线故障和 1 例（4.4%）导线移位。在 14 例（60.9%）患者中，被移除的装置为起搏器，而在 9 例（39.1%）患者中为植入式心律转复除颤器。在 41 根导线中，25 根（60.9%）为右心室导线，14 根（34%）为心房导线，2 根（4.8%）为冠状窦电极。前序操作距本次操作的中位时间为 74 个月（25-180 个月）。单独使用 Evolution 系统实现了 19 例（82%）患者（35 根导线）的完全程序成功。通过圈套术完全移除了 4 根导线，而在另外 2 根导线中，通过遗留心室尖端小于 1.5 cm 实现了部分成功。临床成功率为 100%，所有患者均未出现重大并发症，顺利出院。
我们的经验证实，Evolution 系统的机械技术是一种有效治疗慢性植入起搏器/ICD 导线的一线方法。需要进一步研究以评估与其他技术相比的成功率和并发症发生率。
