Aytemir Kudret, Yorgun Hikmet, Canpolat Uğur, Şahiner M Levent, Kaya Ergün Barış, Evranos Banu, Özer Necla
Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey.
Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
Europace. 2016 Jul;18(7):1043-8. doi: 10.1093/europace/euv245. Epub 2015 Oct 14.
In parallel with increasing implantation rates and patients' longer life expectancy, the need for transvenous lead extraction (TLE) as a specialized procedure has shown a significant growth over years. Herein, we aimed to present our initial experience in TLE by using a novel TightRail™ Rotating Mechanical Dilator Sheath.
Between October 2014 and March 2015, a total of 42 leads in 23 patients were removed at our tertiary referral centre. All of the extracted leads were >12 months old and indications for extraction were based on the recommendations of the Heart Rhythm Society. The leads were removed by using the TightRail™ Mechanical Dilator Sheath (Spectranetics Corporation) with the rotational cutting force only. Indications for lead removal included cardiac device infection in 12 (52.2%) cases, lead malfunction in the 10 (43.5%) cases, and upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) in the remaining 1 case (4.3%). The extracted devices were pacemaker in 10 (43.4%) cases, implantable cardioverter-defibrillator (ICD) in 7 (30.4%) cases, and CRT in the remaining 6 (26.0%) subjects. Among 42 leads, 10 (23.8%) were right ventricular, 14 (33.3%) were atrial, 13 (31.0%) were defibrilator, and 5 (11.9%) were coronary sinus electrodes. The median time from implantation was 72 (18-216) months. Complete procedural success with TightRail™ system alone was achieved in 22 (95.7%) patients (41/42 leads) and overall clinical success was 100%. One right ventricular lead was completely removed with the help of femoral snare. All the patients were discharged uneventfully without any complication.
Our preliminary data with small sample size show that TightRail™ Mechanical Dilator Sheath is a new useful tool for chronically implanted pacemaker (PM)/ICD leads. Continued investigation including large patient cohort is required to evaluate success and complication rates in comparison to other tools and techniques.
随着植入率的提高和患者预期寿命的延长，作为一种专门的操作，经静脉导线拔除术（TLE）的需求在过去几年中显著增长。在此，我们旨在介绍使用新型TightRail™旋转机械扩张器鞘进行TLE的初步经验。
2014年10月至2015年3月期间，我们三级转诊中心共为23例患者拔除了42根导线。所有拔除的导线均植入超过12个月，拔除指征基于心律协会的建议。仅使用TightRail™机械扩张器鞘（Spectranetics公司）通过旋转切割力拔除导线。拔除导线的指征包括12例（52.2%）心脏设备感染、10例（43.5%）导线故障以及其余1例（4.3%）升级为心脏再同步治疗除颤器（CRT-D）。拔除的设备中，10例（43.4%）为起搏器，7例（30.4%）为植入式心律转复除颤器（ICD），其余6例（26.0%）为CRT。在42根导线中，10根（23.8%）为右心室导线，14根（33.3%）为心房导线，13根（31.0%）为除颤器导线，5根（11.9%）为冠状窦电极。植入后的中位时间为72（18 - 216）个月。仅使用TightRail™系统就使22例（95.7%）患者（41/42根导线）获得了完全手术成功，总体临床成功率为100%。借助股静脉圈套器完全拔除了1根右心室导线。所有患者均顺利出院，无任何并发症。
我们小样本量的初步数据表明，TightRail™机械扩张器鞘是用于长期植入的起搏器（PM）/ICD导线的一种新型有用工具。与其他工具和技术相比，需要包括大样本患者队列的持续研究来评估成功率和并发症发生率。
