Second Clinical Department of Cardiology, Regional District Hospital, Kielce, Poland.
Kardiol Pol. 2013;71(4):366-72. doi: 10.5603/KP.2013.0064.
Despite advances in electrotherapy, late complications constitute an increasing clinical and therapeutic problem. Transvenous lead extraction (TLE) is becoming a safe and effective approach to the treatment of such complications.
To assess indications for TLE and to evaluate safety and efficacy of TLE procedures.
A retrospective clinical analysis of 100 patients with complications of electrotherapy admitted to a tertiary care centre in 2008-2011.
In 2008-2011, the number of electrotherapy complications increased markedly. The most frequent reason for TLE was lead dysfunction (62% of patients, including 31% with an implanted cardioverter-defibrillator [ICD] and 31% with a pacemaker [PM]). The most common type of lead dysfunction was conductor damage (38% of patients, including 23% with ICD, 15% with PM), followed by late myocardial perforation (14% of patients, including 7% with ICD, 7% with PM), abnormal course of the lead (7% of patients, including 1% with ICD, 6% with PM), and lead insulation failure (3% of patients). Other reasons for TLE were infectious complications (24% of patients, including 15% with PM pocket infection), venous insufficiency (17% of patients, including 10% in whom an indwelling lead was a direct obstacle to switching the pacing mode), and the need to switch the pacing mode (4% of patients). Procedural efficacy was 96% (lead fragments were left in place in 4% of patients). No significant clinical complications were observed in any of the patients in the periprocedural period.
Clinical manifestations of electrotherapy complications in the study group varied and included a relatively small number of infectious complications (24%) and a relatively large number of late myocardial perforations (14%). Efficacy and safety of the procedures were very high.
尽管电疗技术不断进步，但迟发性并发症仍是日益严峻的临床和治疗问题。经静脉导线拔除术（TLE）已成为治疗此类并发症的安全有效方法。
评估 TLE 的适应证，并评估 TLE 操作的安全性和有效性。
对 2008 年至 2011 年期间在三级医疗中心因电疗并发症住院的 100 例患者进行回顾性临床分析。
2008 年至 2011 年，电疗并发症数量显著增加。TLE 的最常见原因是导线功能障碍（62%的患者，包括 31%的植入式心脏转复除颤器[ICD]和 31%的起搏器[PM]）。最常见的导线功能障碍类型是导体损坏（38%的患者，包括 23%的 ICD、15%的 PM），其次是迟发性心肌穿孔（14%的患者，包括 7%的 ICD、7%的 PM）、导线异常走行（7%的患者，包括 1%的 ICD、6%的 PM）和导线绝缘故障（3%的患者）。TLE 的其他原因包括感染性并发症（24%的患者，包括 15%的 PM 囊袋感染）、静脉功能不全（17%的患者，包括 10%的患者留置导线直接妨碍起搏模式转换）和需要转换起搏模式（4%的患者）。操作成功率为 96%（4%的患者有导线碎片残留）。围手术期内所有患者均未观察到明显的临床并发症。
研究组电疗并发症的临床表现各不相同，包括相对较少的感染性并发症（24%）和较多的迟发性心肌穿孔（14%）。该操作的疗效和安全性非常高。
