Jacheć Wojciech, Tomasik Andrzej, Polewczyk Anna, Kutarski Andrzej
2nd Department of Cardiology, Medical Faculty with Dentistry Division in Zabrze, Silesian Medical University, Katowice, Poland.
2nd Clinical Cardiology Department, Świętokrzyskie Cardiology Center, Kielce, Poland.
Pacing Clin Electrophysiol. 2017 Oct;40(10):1139-1146. doi: 10.1111/pace.13173. Epub 2017 Sep 27.
Implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) systems are considered as having higher risk of complication and shorter durability but reasons of this multifactorial phenomenon remain unclear. We aimed to analyze this problem in population of patients with ICD leads referred for lead extraction (TLE).
We have compared TLE indications, procedural results, and defined the long-term outcomes of TLE in patients with ICD/CRT-D devices (n = 482, ICD (+)) with lead extractions in patients with standard pacemakers (n = 1,402, ICD (-)). Demographic, clinical characteristics, and procedural outcomes were ascertained from single, primary operator registry. Long-term survival data were provided by the National Health Fund.
The ICD (+) subgroup had a significantly higher incidence rate of either infective or noninfective indications for TLE. The clinical success rate of extraction was 99.2% in ICD (+) versus 97.4% in ICD (-) (P = 0.05) at a complication rate of 1.04% versus 2.14% (NS), respectively. In the median follow-up of 3.39 years, 142 patients from the ICD (+) subgroup and 303 from the ICD (-) subgroup died. The highest mortality rate of 41.1% was observed in the ICD (+) subgroup with infective indications. Infection, renal failure, diabetes, and age were the multivariate factors associated with increased mortality in the ICD (+) subgroup.
ICD leads remain more vulnerable, with respect to mechanical failure and their propensity to infection, in comparison to pacing leads. Their TLE is very effective at least complication rate, when performed by a highly skilled and experienced operator. However, long-term mortality after their TLE is high and is affected mostly by infections or patient-related factors.
植入式心脏复律除颤器（ICD）和心脏再同步治疗除颤器（CRT-D）系统被认为具有较高的并发症风险和较短的耐用性，但这种多因素现象的原因仍不清楚。我们旨在对因导线拔除（TLE）而转诊的ICD导线患者群体中的这一问题进行分析。
我们比较了TLE的适应症、手术结果，并确定了ICD/CRT-D设备患者（n = 482，ICD（+））与标准起搏器患者（n = 1402，ICD（-））导线拔除的长期结局。人口统计学、临床特征和手术结果来自单一的主刀医生登记处。长期生存数据由国家卫生基金提供。
ICD（+）亚组因感染性或非感染性适应症进行TLE的发生率显著更高。ICD（+）组的拔除临床成功率为99.2%，而ICD（-）组为97.4%（P = 0.05），并发症发生率分别为1.04%和2.14%（无显著性差异）。在中位随访3.39年时，ICD（+）亚组有142例患者死亡，ICD（-）亚组有303例患者死亡。在有感染性适应症的ICD（+）亚组中观察到最高死亡率为41.1%。感染、肾衰竭、糖尿病和年龄是与ICD（+）亚组死亡率增加相关的多变量因素。
与起搏导线相比，ICD导线在机械故障及其感染倾向方面仍然更脆弱。由技术高超且经验丰富的操作人员进行时，其TLE至少在并发症发生率方面非常有效。然而，其TLE后的长期死亡率很高，主要受感染或患者相关因素影响。
