Jo Uk, Kim Jun, Hwang You-Mi, Lee Ji-Hyun, Kim Min-Su, Choi Hyung-Oh, Lee Woo-Seok, Kwon Chang-Hee, Ko Gi-Young, Yoon Hyun-Ki, Nam Gi-Byoung, Choi Kee-Joon, Kim You-Ho
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Korean Circ J. 2016 Mar;46(2):186-96. doi: 10.4070/kcj.2016.46.2.186. Epub 2016 Mar 21.
The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction.
The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups.
The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B.
Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.
由于各种原因，包括感染、血管阻塞和导线故障，需要进行心脏植入式电子设备导线拔除的患者数量正在增加。我们报告了通过使用鹅颈圈套器经下腔途径进行起搏器和除颤器导线经静脉拔除作为一线治疗的经验，并比较了使用鹅颈圈套器拔除与单纯手动牵引拔除的效果。
该研究纳入了23例连续患者（43根导线），他们使用鹅颈圈套器进行了经静脉导线拔除（A组），以及10例连续患者（17根导线），他们使用单纯手动牵引进行了导线拔除（B组）。分析并比较了两组患者的特征、适应证和结果。
A组导线的留置时间（中位数，121天）比B组（中位数，56天；p = 0.000）更长。两组之间在总体操作成功率（69.6%对70%）、临床操作成功率（82.6%对90%）和导线临床成功率（86%对94.1%）方面未观察到差异。A组和B组中，起搏导线根据导线类型的操作成功率分别为89.2%和100%，除颤器导线的操作成功率分别为66.7%和83.3%。A组有3例患者（1例死亡）和B组有2例患者出现了主要并发症。
使用鹅颈圈套器经下腔途径进行起搏器导线经静脉拔除既安全又有效。然而，单独使用下腔途径经静脉拔除除颤器导线的效果欠佳。
