Claridge Simon, Johnson Jonathan, Sadnan Gazi, Behar Jonathan M, Porter Bradley, Sieniewicz Benjamin, Jackson Tom, Webb Jessica, Gould Justin, Sohal Manav, Hamid Shoaib, Patel Nik, Gill Jaswinder, Rinaldi Christopher A
Department of Cardiology, Guy's and St Thomas' Hospital Trust, London, SE1 7EH, UK.
Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK.
Pacing Clin Electrophysiol. 2018 Feb;41(2):155-160. doi: 10.1111/pace.13266. Epub 2018 Jan 24.
A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction.
A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead-related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction.
807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69-171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2-5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0-1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02).
Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.
一部分接受初次导线拔除术的患者需要进行第二次重复拔除。关于这一临床情况的数据很少，此前尚未描述这些手术的易感风险因素或结果。我们试图确定重复导线拔除的发生率、风险因素和结果。
分析了2001年至2015年的拔除手术数据库。确定重复拔除手术，并将拔除指征分为感染和与导线相关的问题。进行单因素和多因素分析以确定重复拔除的预测因素。
在755例患者中确定了807例拔除手术，其中6%需要重复拔除。多因素分析显示，仅初次拔除手术时发生严重并发症（比值比[OR]21.5，95%置信区间[CI]2.69 - 171.92；P < 0.01）、器械复杂性（心脏再同步化器械/植入式心脏复律除颤器）（OR 2.58，95% CI 1.2 - 5.2；P = 0.01）和年龄（每年OR 1.02，95% CI 1.0 - 1.4；P = 0.03）是重复拔除的显著预测因素。与不需要第二次手术的患者相比，因感染而需要重复拔除时死亡率显著增加（36%对23%；P = 0.02）。
6%的病例需要重复导线拔除。器械复杂性、拔除时的年龄和初次拔除时的严重并发症是重复拔除的预测因素。当重复手术是因感染时死亡率显著增加。临床医生应提醒患者，如有感染指征，可能需要进一步拔除以及重复手术风险增加。
