Gomes Sean, Cranney Gregory, Bennett Michael, Li Annette, Giles Robert
Department of Cardiology, Prince of Wales Hospital and University of New South Wales, Sydney 2031, Australia
Department of Cardiology, Prince of Wales Hospital and University of New South Wales, Sydney 2031, Australia.
Europace. 2014 Sep;16(9):1350-5. doi: 10.1093/europace/eut424. Epub 2014 Feb 19.
Indications for cardiovascular implantable electronic devices continue to evolve, which has led to an increasing requirement for transvenous lead extraction. We explore the indications, complications, and success rates involved in the removal of pacemaker and implantable cardioverter-defibrillator (ICD) leads in a high-volume centre, over 20 years.
We performed a retrospective analysis of all consecutive patients undergoing transvenous lead extraction by a single operator at a single centre between 1993 and 2012. Patient characteristics, indications, and outcomes were analysed. A total of 1006 leads were removed from 510 patients. Seventy-two per cent of patients were males. The mean age was 64 years (range 14-96). Indications included systemic infection (25%), pocket infection (40%), lead failure (26%), chronic pain (3%), and other (6%). Ninety-six per cent of leads were completely removed. There was one procedure-related death, and the major complication rate was 0.3%. Infection was the only identified predictor of increased complication (χ² for difference between groups 20, P< 0.0001).
Pacing and ICD leads can be safely extracted with mechanical techniques. The presence of device infection appears to be the major predictor of procedural complications.
心血管植入式电子设备的适应证不断演变，这导致经静脉导线拔除的需求日益增加。我们在一个高容量中心对20多年来起搏器和植入式心脏复律除颤器（ICD）导线拔除的适应证、并发症及成功率进行了探讨。
我们对1993年至2012年间在单一中心由单一操作者进行经静脉导线拔除的所有连续患者进行了回顾性分析。分析了患者特征、适应证及结果。共从510例患者中拔除了1006根导线。72%的患者为男性。平均年龄为64岁（范围14 - 96岁）。适应证包括全身感染（25%）、囊袋感染（40%）、导线故障（26%）、慢性疼痛（3%）及其他（6%）。96%的导线被完全拔除。有1例与手术相关的死亡，主要并发症发生率为0.3%。感染是唯一确定的并发症增加的预测因素（组间差异χ²为20，P < 0.0001）。
采用机械技术可安全拔除起搏导线和ICD导线。设备感染的存在似乎是手术并发症的主要预测因素。
