Mammadli Anar, Vurgun Veysel Kutay, Yıldırım Onur, Altın Ali Timuçin, Candemir Başar, Akyürek Ömer
Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2018 Jan;46(1):54-56. doi: 10.5543/tkda.2017.56239.
With the increasing number of implanted pacemakers and implantable cardioverter defibrillators, removal is required more frequently. Presently described is the transvenous extraction of a 26-year-old Accufix atrial lead using a mechanical dilator sheath. A 50-year-old male patient was admitted to the clinic with a pacemaker pocket infection. The atrial lead was an Accufix Bipolar J-Atrial active fixation lead, a model that was recalled in 1994, after reports of 2 deaths and 2 nonfatal injuries related to protrusion of the J retention wire. Both the atrial and ventricular leads were extracted using a mechanical dilator sheath. The Pacemaker Lead Extraction with the Excimer Sheath (PLEXES) Trial reported that of the 57 Accufix leads randomized to a non-laser approach, only 47% were removed successfully, compared with 96% of laser-randomized cases. Since laser sheaths are not available in Turkey, use of a mechanical dilator sheath was required. To our knowledge, this is the oldest Accufix lead extracted with a non-laser sheath. During the extraction of the ventricular lead, the tip of the lead broke off inside the right ventricle and the residual part was left inside the heart. During 3 months of follow-up, no signs of infection or any other undesirable events were encountered.
随着植入式起搏器和植入式心脏复律除颤器数量的增加，移除需求也越来越频繁。本文描述了使用机械扩张鞘经静脉取出一根26岁的Accufix心房导线的过程。一名50岁男性患者因起搏器囊袋感染入院。心房导线为Accufix双极J型心房主动固定导线，该型号在1994年因有2例死亡和2例与J形固定丝突出相关的非致命伤害报告而被召回。心房和心室导线均使用机械扩张鞘取出。准分子激光鞘起搏器导线取出（PLEXES）试验报告称，在57根随机分配至非激光方法的Accufix导线中，只有47%成功取出，而激光随机分组的病例成功率为96%。由于土耳其没有激光鞘，因此需要使用机械扩张鞘。据我们所知，这是用非激光鞘取出的最旧的Accufix导线。在取出心室导线过程中，导线尖端在右心室内折断，残留部分留在心脏内。在3个月的随访中，未发现感染迹象或任何其他不良事件。
