Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China ; Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China.
J Geriatr Cardiol. 2013 Mar;10(1):3-9. doi: 10.3969/j.issn.1671-5411.2013.01.002.
Implantable cardioverter-defibrillator (ICD) leads might not be extracted especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate transvenous extraction of ICD leads using optimized standard techniques.
We prospectively analyzed clinical characteristics, optimized extraction techniques and the feasibility of extraction for 40 patients (33 males; mean age 47.9 ± 16.1 years) with 42 ICD leads.
Complete procedural success rate was 95.2% (40/42), and the clinical success rate was 97.6% (41/42). One ICD lead required cardiothoracic surgery. Minor complications occurred in three cases (7.5%), and no major complications or death occurred. Locking stylets were used to extract most leads (34, 81.0%) and almost half of the leads (20, 47.6%) required mechanical dilatation to free fibrotic adhesions; these leads had been implanted for a longer period of time than the others (43.7 ± 18.2 vs. 18.4 ± 13.4 months, P < 0.05). Three-quarters of the leads (30, 71.4%) were extracted with locking stylets plus manual traction (12, 28.6%), or mechanical dilatation with counter-traction (18, 42.8%) by the superior vena cava approach and one-quarter of the leads (11, 26.2%) were removed by optimized snare techniques using the femoral vein approach. Median extraction time was 20 min (range 2-68 min) per lead. Linear regression analysis showed that the extraction time was significantly correlated with implant duration (r = 0.70, P < 0.001). Median follow-up was 14.5 months (range 1-58 months), no infection, or procedure-related death occurred in our series.
Our optimized procedure for transvenous extraction of ICD leads provides a practical and low-cost method for standard procedures.
由于成本高和缺乏专业工具，在发展中国家，植入式心脏复律除颤器（ICD）导联可能无法取出。我们旨在评估使用优化的标准技术经静脉取出 ICD 导联。
我们前瞻性分析了 40 例（33 名男性；平均年龄 47.9±16.1 岁）42 个 ICD 导联患者的临床特征、优化的取出技术和取出的可行性。
完全程序成功率为 95.2%（40/42），临床成功率为 97.6%（41/42）。1 例 ICD 导联需要开胸手术。3 例（7.5%）发生轻微并发症，无重大并发症或死亡。锁定导丝用于取出大多数导联（34 个，81.0%），近一半的导联（20 个，47.6%）需要机械扩张以松解纤维性粘连；这些导联的植入时间比其他导联长（43.7±18.2 与 18.4±13.4 个月，P<0.05）。四分之三的导联（30 个，71.4%）采用锁定导丝加手动牵引（12 个，28.6%）或经上腔静脉途径加反向牵引机械扩张（18 个，42.8%）取出，四分之一的导联（11 个，26.2%）采用优化的圈套技术经股静脉途径取出。每根导联的中位取出时间为 20 分钟（范围 2-68 分钟）。线性回归分析显示，取出时间与植入时间显著相关（r=0.70，P<0.001）。中位随访时间为 14.5 个月（范围 1-58 个月），我们的系列研究中无感染或与手术相关的死亡。
我们经静脉取出 ICD 导联的优化程序为标准程序提供了一种实用且低成本的方法。
