Brinker Jeffrey
Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, 7125Q, Baltimore, MD, 21287, USA,
Curr Treat Options Cardiovasc Med. 2014 Aug;16(8):325. doi: 10.1007/s11936-014-0325-2.
Cardiovascular implantable electronic devices (CIED) are a remarkable success story. These systems are widely used to prevent symptomatic bradycardia, treat malignant tachyarrhythmia, and to restore a more physiologic contraction to a failing left ventricle. Implantation of a CIED usually involves a lifelong commitment to this therapy, which, unfortunately, is not free from complication requiring removal and/or replacement of all or part of the system. The major obstacle to removal of a CIED is the fibrous attachments that develop between a lead and co-existent leads, veins, and the heart. This process increases over time such that, by one year, removal by traction alone may be problematic and, if aggressive, result in complication. Physicians, surgeons, and engineers have refined techniques of percutaneous lead extraction and developed tools, which have facilitated the process, increased success, and lowered the incidence of complication. Extraction may be performed for a variety of indications some of which are unanimously agreed upon while others remain controversial. Proponents of a broadened application of extraction have proffered the concept of 'lead management,' which includes the removal of all leads that are not clinically relevant to the patient. The benefit of this approach would be to limit the risk of future complication, such as venous occlusion or thromboembolism, and to obviate the increase in difficulty of extraction (due to longer implant duration) that might accompany removal should that be required in the future. Intuitively appealing as this approach might be, there is little evidence supporting it, and the extraordinarily large number of patients currently implanted with recalled ICD leads is indicative of the potential impact this practice may have. This review will discuss extraction, its indications, and outcomes.
心血管植入式电子设备（CIED）是一个显著的成功案例。这些系统被广泛用于预防有症状的心动过缓、治疗恶性快速心律失常以及恢复衰竭左心室更生理性的收缩。植入CIED通常意味着终身接受这种治疗，不幸的是，这种治疗并非没有并发症，可能需要移除和/或更换全部或部分系统。移除CIED的主要障碍是导线与共存导线、静脉和心脏之间形成的纤维性粘连。这个过程会随着时间推移而加重，以至于到一年时，仅靠牵引移除可能会有问题，而且如果操作激进，会导致并发症。内科医生、外科医生和工程师已经改进了经皮导线拔除技术并开发了工具，这促进了该过程，提高了成功率并降低了并发症发生率。拔除可因多种适应证而进行，其中一些已达成一致，而另一些仍存在争议。支持扩大拔除应用的人提出了“导线管理”的概念，其中包括移除所有与患者临床无关的导线。这种方法的好处是限制未来并发症的风险，如静脉阻塞或血栓栓塞，并避免未来可能需要移除时因植入时间较长而导致的拔除难度增加。尽管这种方法可能直观上很有吸引力，但几乎没有证据支持它，而且目前植入召回的植入式心脏除颤器（ICD）导线的患者数量众多，表明这种做法可能产生的潜在影响。本综述将讨论拔除及其适应证和结果。
