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心脏移植受者体内植入式心律转复除颤器导线材料残留的频率及临床影响

Frequency and clinical impact of retained implantable cardioverter defibrillator lead materials in heart transplant recipients.

作者信息

Kim Jun, Hwang Jongmin, Choi Jin Hee, Choi Hyo-In, Kim Min-Seok, Jung Sung-Ho, Nam Gi-Byoung, Choi Kee-Joon, Lee Jae Won, Kim You-Ho, Kim Jae-Joong

机构信息

Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

PLoS One. 2017 May 2;12(5):e0176925. doi: 10.1371/journal.pone.0176925. eCollection 2017.

Abstract

End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.

摘要

患有植入式心脏复律除颤器(ICD)且有/无心脏再同步治疗(CRT-D)的终末期心力衰竭患者通常需要进行心脏移植(HTPL)作为最后的治疗手段。我们旨在评估HTPL患者中ICD导线材料残留的频率及其临床影响。在这项回顾性单中心研究中,我们检查了1992年1月至2014年7月期间接受HTPL的ICD和CRT-D患者的临床记录和胸部X光片。在40例接受HTPL的ICD和CRT-D患者中,19例(47.5%)患者的中心静脉系统内有ICD导线材料残留。HTPL后ICD导线材料残留更常见于从植入到HTPL间隔时间较长的患者。HTPL后没有患者接受拔除手术。所有患者均无症状,未出现与ICD导线材料残留相关的严重并发症或死亡。7例(7/40,17.5%)无ICD导线材料残留的患者在随访期间(中位时间29.5个月)接受了磁共振成像(MRI)检查;没有ICD导线材料残留的患者接受MRI检查。考虑到MRI在HTPL患者中的普遍应用,需要进一步研究ICD导线材料残留的预防性拔除以及MRI在这些患者中的安全性。

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