Bracke F A, Meijer A, van Gelder B
Neth Heart J. 2001 Jun;9(3):117-122.
We report our experience with lead extraction in patients with an implantable cardioverter defibrillator (ICD) and discuss the indications for extraction in these patients.
Eighteen patients with an ICD (mean age 58±12 years) were referred for lead extraction: two patients with infection and 16 with lead dysfunction.
Lead extraction was performed with a laser sheath (Excimer) if traction with a locking device was insufficient. New leads were implanted during the same procedure, if applicable.
Shock leads were successfully extracted in 16 patients and additional pace-sense leads in seven patients. In two patients, the shock conductor was considered unaffected and only a pace-sense lead was exchanged or an additional pace-sense lead inserted. After extraction, new shock leads were implanted in 14 patients. Major complications occurred in one patient: a pericardial tamponade after perforation of the superior caval vein necessitating acute surgery.
Lead extraction with a laser sheath is effective in ICD patients, but major complications can occur. Our current policy with malfunctioning leads is to extract all leads in which insulation defects cannot be ruled out to avoid interference, but to abandon leads that are without insulation defects and properly insulated. In case of infection, extraction remains the primary treatment of choice.
我们报告了植入式心脏复律除颤器（ICD）患者的导线拔除经验，并讨论了这些患者的拔除指征。
18例ICD患者（平均年龄58±12岁）被转诊进行导线拔除：2例感染患者和16例导线功能障碍患者。
如果使用锁定装置牵引不足，则使用激光鞘（准分子）进行导线拔除。如果适用，在同一手术过程中植入新导线。
16例患者成功拔除除颤导线，7例患者成功拔除额外的起搏感知导线。2例患者中，除颤导线被认为未受影响，仅更换了起搏感知导线或插入了额外的起搏感知导线。拔除后，14例患者植入了新的除颤导线。1例患者发生了主要并发症：上腔静脉穿孔后心包填塞，需要进行急诊手术。
使用激光鞘进行导线拔除对ICD患者有效，但可能发生主要并发症。我们目前对于故障导线的策略是，拔除所有不能排除绝缘缺陷的导线以避免干扰，但放弃无绝缘缺陷且绝缘良好的导线。在感染的情况下，拔除仍然是主要的治疗选择。
