Department of Cardiology, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland.
Europace. 2012 Jul;14(7):994-1001. doi: 10.1093/europace/eur384. Epub 2012 Jan 13.
The aim of our study was to characterize specific tissue reaction of encapsulating lead tissue in patients who underwent transvenous lead removal and evaluate condition of the outer leads' insulation.
Fifty-six leads (27 atrial, 24 ventricular, 5 implantable cardioverter-defibrillators) were removed from 31 patients (mean age 70 years). Indications for removal were chronic pocket infection (CPI) (9 patients ), infective endocarditis (IE) (6), and non-infective indications (NI) (16). Leads with their surrounding tissue were fixed in paraformaldehyde. Tissues were embedded in paraffin wax, stained with haematoxylin-eosin, and examined histologically. The outer leads' insulations were examined in stereomicroscope. The mean lead age encapsulated by connective tissue sheath was 89, whereas encapsulated by granulation tissue was 47.34 months (P= 0.03). Calcification was present in 13 patients. Haemosiderine was observed only in patients with severe abrasion with perforation in the pocket (P= 0.04). Vasculogenesis was present in one (6%) with NI, five (56%) with CPI, and three (50%) with IE (P= 0.02) and was associated with elevated white blood cells (WBC) (P= 0.04). Eosinophilia was associated with elevated WBC (P= 0.04). The most frequently observed are third level of degradation (severe with perforation) in the intracardiac part of the silicone leads. Insulation damage due to environmental stress cracking concerned all leads with polyurethane overlay.
Granulation in encapsulating tissue was present in patients with younger leads. Vasculogenesis was observed more often in IE and CPI patients, which might indirectly indicate thickness of the sheath. Eosinophila may indicate allergic component of inflammation. Insulation damage frequently concerned the intracardiac part.
本研究旨在描述经静脉导线取出术患者体内包裹铅组织的特定组织反应，并评估外部导线绝缘层的状况。
从 31 名患者（平均年龄 70 岁）中取出 56 根导线（27 根心房，24 根心室，5 根植入式心脏复律除颤器）。取出导线的指征为慢性囊袋感染（CPI）（9 例）、感染性心内膜炎（IE）（6 例）和非感染性指征（NI）（16 例）。将带周围组织的导线固定在多聚甲醛中。组织用石蜡包埋，苏木精-伊红染色，组织学检查。在立体显微镜下检查外部导线的绝缘层。被结缔组织鞘包裹的导线的平均使用年限为 89 个月，而被肉芽组织包裹的导线的使用年限为 47.34 个月（P=0.03）。13 例患者存在钙化。仅在口袋严重磨损且穿孔的患者中观察到含铁血黄素（P=0.04）。血管生成存在于 1 例（6%）NI 患者、5 例（56%）CPI 患者和 3 例（50%）IE 患者中（P=0.02），与白细胞计数升高（P=0.04）相关。嗜酸性粒细胞增多与白细胞计数升高有关（P=0.04）。最常观察到的是硅酮导线心内部分的三级降解（严重伴穿孔）。由于环境应力开裂导致的绝缘损坏涉及所有带有聚亚安酯覆盖层的导线。
肉芽组织包裹的年轻患者的导线更容易出现肉芽组织。血管生成更常见于 IE 和 CPI 患者，这可能间接表明鞘的厚度。嗜酸性粒细胞增多可能表明炎症的过敏成分。绝缘损坏通常涉及心内部分。
