Boczar Krzysztof, Ząbek Andrzej, Haberka Kazimierz, Hardzina Małgorzata, Dębski Maciej, Rydlewska Anna, Nowosielska-Ząbek Ewa, Lelakowski Jacek, Małecka Barbara
Department of Electrocardiology, John Paul II Hospital, Kraków, Poland.
Department of Electrocardiology, John Paul II Hospital, Kraków, Poland; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Adv Clin Exp Med. 2016 Jan-Feb;25(1):83-91. doi: 10.17219/acem/42317.
Venous stenosis and occlusion in the presence of endocardial leads constitute one of the complications of permanent cardiac pacing either by pacemaker, implantable cardioverter-defibrillator or cardiac resynchronization therapy.
The aim of this study was to assess the incidence of stenosis and occlusions and determine the risk factors in patients with endocardial leads in a prospective single-center study.
Two hundred eighty consecutive patients aged 25-95 years (male 68.8%) were included. A contrast venography examination of the ipsilateral access vein was performed. The whole study population was divided into 2 groups, based on the presence (group I) or absence (group II) of endocardial leads.
Venous stenosis/occlusion was identified in 51 patients (37.5%) in group I and in 3 patients (3.6%) in group II; p < 0.0001. The lead presence most highly correlated with venous complications (OR = 4.172; p < 0.001). In patients with endocardial leads divided into I A and I B according to venous patency diabetes mellitus was proved in multivariate analysis to be the only protective factor against the development of venous stenosis/occlusion (OR = 0.473; p = 0.010).
The presence of endocardial leads is a predisposing factor for venous stenosis/occlusion and increases the risk 4-fold. The venous lesions in the presence of endocardial leads are less frequent among patients with diabetes mellitus.
心内膜导线存在时的静脉狭窄和闭塞是永久性心脏起搏（通过起搏器、植入式心脏复律除颤器或心脏再同步治疗）的并发症之一。
本前瞻性单中心研究旨在评估狭窄和闭塞的发生率，并确定有心内膜导线患者的危险因素。
纳入280例年龄在25 - 95岁的连续患者（男性占68.8%）。对同侧入路静脉进行造影检查。根据心内膜导线的有无，将整个研究人群分为两组（I组有导线，II组无导线）。
I组51例患者（37.5%）发现静脉狭窄/闭塞，II组3例患者（3.6%）发现；p < 0.0001。导线的存在与静脉并发症相关性最高（OR = 4.172；p < 0.001）。在心内膜导线患者中，根据静脉通畅情况分为IA组和IB组，多因素分析显示糖尿病是预防静脉狭窄/闭塞发生的唯一保护因素（OR = 0.473；p = 0.010）。
心内膜导线的存在是静脉狭窄/闭塞的诱发因素，使风险增加4倍。在心内膜导线存在的情况下，糖尿病患者的静脉病变较少见。
