经静脉取出起搏器和植入式心脏复律除颤器导线在 80 岁以下和 80 岁以上患者中的安全性和有效性。

Safety and effectiveness of transvenous extraction of pacemaker and implantable cardioverter-defibrillator leads in patients under or over 80 years of age.

机构信息

Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.

出版信息

Kardiol Pol. 2013;71(2):130-5. doi: 10.5603/KP.2013.0005.

DOI:10.5603/KP.2013.0005

PMID:23575705

Abstract

BACKGROUND

Progressive aging of the population and the increasing number of complications of electrotherapy procedures are the main reasons of a remarkable increase in the number of transvenous extraction procedures of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) leads in the elderly patients.

AIM

To assess the safety and effectiveness of such procedures in patients under or over 80 years of age. The study included all patients who underwent transvenous PM/ICD lead extraction in 2003-2011.

METHODS

All patients were divided into two groups based on their age at the time of the procedure: group A included patients under 80 years of age (134 patients; 97 male, 37 female) and group B included patients over 80 years of age (26 patients; 16 male, 10 female).

RESULTS

No differences were found between the two groups in terms of gender proportions, comorbidities, New York Heart Association (NYHA) functional class, and left ventricular ejection fraction. In total, 220 leads were removed (group A: 63 defibrillating and 122 pacing leads, group B: 2 defibrillating and 33 pacing leads). The most common indication for the lead removal procedure in both groups was infection, either in the form of PM/ICD pocket infection (46 and 13 cases, respectively) or infective endocarditis (18 and 2 cases, respectively). Procedural outcomes in both groups were not statistically different in terms of the final outcome or complication rates. The results in groups A and B were as follows: complete success 95.5% vs. 96.2%, respectively, clinical success 3% vs. 3.8%, respectively, and failure 1.5% vs. 0%, respectively, with no significant differences between the groups. No major complications of the procedure were observed in either of the groups.

CONCLUSIONS

Our findings indicate that transvenous extraction of PM/ICD leads appears to be a safe and effective procedure both in relatively younger patients and in patients over 80 years of age.

摘要

背景

人口老龄化的不断发展以及电疗程序并发症的不断增加，是导致老年患者中心静脉起搏器（PM）和植入式心律转复除颤器（ICD）导联经静脉取出术数量显著增加的主要原因。

目的

评估 80 岁以下和 80 岁以上患者行此类手术的安全性和有效性。该研究纳入了 2003 年至 2011 年间所有行经静脉 PM/ICD 导联取出术的患者。

方法

所有患者均根据手术时的年龄分为两组：A 组为 80 岁以下患者（134 例，男 97 例，女 37 例），B 组为 80 岁以上患者（26 例，男 16 例，女 10 例）。

结果

两组患者在性别比例、合并症、纽约心脏协会（NYHA）功能分级和左心室射血分数方面无差异。共取出 220 根导联（A 组：除颤 63 根，起搏 122 根；B 组：除颤 2 根，起搏 33 根）。两组患者中最常见的导联取出适应证均为感染，包括 PM/ICD 囊袋感染（分别为 46 例和 13 例）或感染性心内膜炎（分别为 18 例和 2 例）。两组患者的最终结局或并发症发生率在手术结果方面无统计学差异。A 组和 B 组的结果如下：完全成功分别为 95.5%和 96.2%，临床成功分别为 3%和 3.8%，失败分别为 1.5%和 0%，组间无显著差异。两组均未发生重大手术并发症。