Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
Boston Scientific Corporation, 300 Boston Scientific Way, Malborough, MA 01752, USA.
Europace. 2017 Dec 1;19(12):1994-2000. doi: 10.1093/europace/euw367.
End-stage renal disease (ESRD) increases the risk of implantable cardioverter-defibrillator (ICD) infection. We sought to define outcomes of lead extraction in patients with ESRD.
Implantable cardioverter-defibrillator lead extractions at our institution from January 2006 to March 2014 were stratified by absence (Control-Ex, n = 465) or presence (ESRD-Ex, n = 43) of ESRD. Procedural outcomes and survival were determined by medical records review. Survival in the ESRD-Ex group was compared with a contemporaneous cohort with ESRD undergoing ICD lead implantation (ESRD-I, n = 127). Among extraction patients, those with ESRD were more likely to be extracted for infection (74.4% vs. 28.6%, P < 0.001). Extraction procedure success (Control-Ex: 97% vs. ESRD-Ex: 93%, P = 0.17) and procedural deaths (Control-Ex: 1.1% vs. ESRD-Ex: 2.3%, P = 0.413) were similar. Survival 1 year following extraction was worse in the ESRD-Ex group compared with the Control-Ex, with a survival rate of 65.6% vs. 92.6% (P < 0.001); these curves continued to diverge through year 3. One-year survival in the ESRD-Ex group was worse than among ESRD patients undergoing ICD implant (ESRD-I), but these curves converged and survival was similar by year 3.
Implantable cardioverter-defibrillator lead extraction can be performed safely and effectively in patients with ESRD. However, despite high rates of procedural success, long-term mortality following extraction in ESRD patients is substantial. Much of the long-term mortality risk appears to be accounted for by the presence of ESRD and an indication for an ICD.
终末期肾病（ESRD）会增加植入式心脏复律除颤器（ICD）感染的风险。我们旨在确定 ESRD 患者心内除颤器导线拔除的结局。
对 2006 年 1 月至 2014 年 3 月我院行 ICD 导线拔除术患者进行分组，分为无 ESRD（对照组-EX，n=465）和存在 ESRD（ESRD-EX，n=43）。通过病历回顾确定手术结局和生存情况。ESRD-EX 组的生存情况与同期行 ICD 导线植入术的 ESRD 患者（ESRD-I，n=127）进行比较。在接受拔除术的患者中，因感染而拔除的患者中 ESRD 患者比例更高（74.4% vs. 28.6%，P<0.001）。两组的手术成功率（对照组-EX：97% vs. ESRD-EX：93%，P=0.17）和手术死亡率（对照组-EX：1.1% vs. ESRD-EX：2.3%，P=0.413）相似。与对照组-EX 相比，ESRD-EX 组患者拔除术后 1 年的生存率较差，为 65.6% vs. 92.6%（P<0.001），这两条曲线在 3 年内持续分离。ESRD-EX 组患者 1 年生存率差于行 ICD 植入术的 ESRD 患者（ESRD-I），但这两条曲线在 3 年内趋于一致，生存率相似。
ESRD 患者可安全有效地行 ICD 导线拔除术。然而，尽管手术成功率较高，但 ESRD 患者拔除术后的长期死亡率仍然很高。大多数长期死亡率风险似乎归因于 ESRD 的存在和 ICD 的适应证。
