Ribeiro Sílvia, Leite Luís, Oliveira João, Pereira Maria João, Pinheiro Carla, Ermida Paulo, António Natália, Ventura Miguel, Cristóvão João, Elvas Luís, Providência Luís
Serviço de Cardiologia, Hospital de Guimarães, Guimarães, Portugal.
Serviço de Cardiologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
Rev Port Cardiol. 2015 Dec;34(12):739-44. doi: 10.1016/j.repc.2015.07.008. Epub 2015 Nov 18.
The number and complexity of cardiac implantable electronic devices (CIEDs) have increased, as has the number of related complications, often leading to removal of the implanted system. The aim of this study was to characterize transvenous explantation/extraction of CIED leads in a reference center.
This was a descriptive observational study of patients consecutively admitted from January 2009 to May 2014 for transvenous lead extraction.
The sample consisted of 109 patients, with a mean age of 64.6±16.62 years, 73.1% male. The main indication for lead extraction was CIED infection. The mean time from first implantation to lead removal was 5.6±4.89 years. Blood cultures were positive in 32.8% of cases and 29% of patients had vegetations on echocardiography. A total of 228 cardiac leads were removed, of which 58.8% were ventricular, 32.4% atrial and 8.8% coronary sinus. Complete clinical success was achieved in 97.2% of cases, while procedural success was complete in 93.4% and partial in 5.3%. The complications reported were three cases of significant pocket hematoma, one of subclavian vein thrombosis and three of cardiac tamponade, effectively treated by pericardiocentesis.
Transvenous explantion or extraction of CIED leads was highly effective. A high level of experience is an essential factor in the success and safety of the procedure.
心脏植入式电子设备（CIED）的数量和复杂性不断增加，相关并发症的数量也随之上升，这常常导致植入系统被移除。本研究的目的是在一个参考中心对经静脉取出/拔除CIED导线的情况进行特征描述。
这是一项对2009年1月至2014年5月连续收治的进行经静脉导线拔除的患者的描述性观察研究。
样本包括109例患者，平均年龄为64.6±16.62岁，男性占73.1%。导线拔除的主要指征是CIED感染。从首次植入到导线拔除的平均时间为5.6±4.89年。32.8%的病例血培养呈阳性，29%的患者在超声心动图检查中有赘生物。共拔除228根心脏导线，其中58.8%为心室导线，32.4%为心房导线，8.8%为冠状静脉窦导线。97.2%的病例取得了完全临床成功，而手术成功率为完全成功的占93.4%，部分成功的占5.3%。报告的并发症有3例严重的囊袋血肿、1例锁骨下静脉血栓形成和3例心脏压塞，通过心包穿刺有效治疗。
经静脉取出或拔除CIED导线非常有效。丰富的经验是该手术成功与安全的关键因素。
