Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Cardiol J. 2013;20(2):161-9. doi: 10.5603/CJ.2013.0029.
Retrospective analysis of effectiveness, technical problems, and complications of transvenous extraction of leads with the free endings migrated to the cardiovascular system (CVS).
A 5-year-old database of transvenous lead extraction (TLE) procedures comprising 906 patients with 1563 leads being removed was analyzed. TLE procedures of leads migrated in the CVS were compared with TLE procedures of leads with their proximal ends accessible in the pacemaker/implantable cardioverter-defibrillator (PM/ICD) pocket.
In our material, the phenomenon of leads migration occurred in 5% of patients referred for TLE and affected most frequently unipolar and atrial leads. The presence of migrating leads was associated with local venous occlusion in 64% of patients. Removal of migrating leads required other techniques than extraction of leads with their proximal ends accessible in the PM/ICD pocket. More than 95% of migrating leads were extracted transvenously, but procedures were significantly longer. The presence of other leads made extraction of migrated leads even more complicated. Effectiveness and complication rates for removal of migrated leads and leads accessible in the PM/ICD pocket were similar.
We postulate that every lead migrating in the CVS should be considered for TLE. However, this extraction is technically more difficult and challenging than extraction of leads accessible in the PM/ICD pocket.
回顾性分析经静脉提取导丝（TLE）治疗心血管系统（CVS）内游离端迁移的有效性、技术问题和并发症。
分析了一个包含 906 例患者和 1563 条导丝的 5 年 TLE 手术数据库，这些导丝被移除。将 CVS 内迁移导丝的 TLE 手术与 PM/ICD 口袋内近端可触及导丝的 TLE 手术进行比较。
在我们的资料中，5%的 TLE 患者出现了导丝迁移现象，最常影响单极和心房导丝。64%的患者存在迁移导丝的现象与局部静脉闭塞有关。与 PM/ICD 口袋内近端可触及导丝的提取相比，需要采用其他技术来提取迁移导丝。超过 95%的迁移导丝经静脉提取，但手术时间明显延长。其他导丝的存在使提取迁移导丝更加复杂。迁移导丝和 PM/ICD 口袋内可触及导丝的去除效果和并发症发生率相似。
我们推测，每一条在 CVS 中迁移的导丝都应考虑进行 TLE。然而，与 PM/ICD 口袋内可触及导丝的提取相比，这种提取在技术上更困难和具有挑战性。
