Catanzaro John N, Zviman Menekham, Kolandaivelu Aravindan, Nazarian Saman, Halperin Henry, Berger Ronald D, Brinker Jeffrey A, Cheng Alan
Section of Cardiac Electrophysiology, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD, United States.
Int J Cardiol Heart Vessel. 2014 Mar 22;3:75-77. doi: 10.1016/j.ijchv.2014.03.008. eCollection 2014 Jun.
Excimer laser energy is often required to extract chronically indwelling pacemaker and defibrillator leads from the vasculature and myocardium. This technique can be associated with vascular and right ventricular (RV) injuries. We sought to develop a safer, more effective method by applying site-specific delivery of electrosurgical energy (EE).
Utilizing a polyacrylamide gel model to simulate soft tissue density, active and passive fixation defibrillator and pacemaker leads were implanted and manually extracted with and without EE delivered to the cathode. The amount of force required for complete removal was measured using a force transducer. The procedure was then repeated in an acute pig model to demonstrate proof of safety. Post mortem gross and histologic specimens were collected from the implantation site.
In the gel model, the force required for extraction, using manual traction in the active (83.7 g) and passive (74.6 g) fixation ICD leads, was reduced by 37.8% and 33.5%, respectively with EE (both p < 0.01). The force required for extraction, using manual traction in the active (85.2 g) and passive (71.9 g) fixation pacemaker leads, was reduced by 64.4% and 42.6%, respectively with EE (both p < 0.01). In an acute implantation pig model using an active fixation lead, delivery of EE to the cathode (n = 6) reduced the force required to manually extract the lead (140 g +/- 32.5 versus 82 g +/- 14.7, p = 0.03). Post mortem analysis of the RV displayed formation of an epicardial hemorrhagic lesion that was also present after manual traction and EE. There was absence of pericardial effusion, perforation, and ventricular arrhythmia.
Site-specific delivery of EE to areas of exposed metal along the lead decreased the force necessary for lead extraction in an in vitro and in vivo model. Further studies are needed to evaluate its application in clinical care.
从血管系统和心肌中取出长期植入的起搏器和除颤器导线通常需要准分子激光能量。该技术可能会导致血管和右心室（RV）损伤。我们试图通过应用电外科能量（EE）的部位特异性递送来开发一种更安全、更有效的方法。
利用聚丙烯酰胺凝胶模型模拟软组织密度，植入主动和被动固定的除颤器及起搏器导线，并在阴极施加或不施加EE的情况下手动取出。使用力传感器测量完全取出所需的力。然后在急性猪模型中重复该过程以证明安全性。从植入部位采集死后大体标本和组织学标本。
在凝胶模型中，主动固定（83.7 g）和被动固定（74.6 g）的植入式心律转复除颤器（ICD）导线采用手动牵引时，取出所需的力分别因EE而降低了37.8%和33.5%（均p < 0.01）。主动固定（85.2 g）和被动固定（71.9 g）的起搏器导线采用手动牵引时，取出所需的力分别因EE而降低了64.4%和42.6%（均p < 0.01）。在使用主动固定导线的急性植入猪模型中，向阴极递送EE（n = 6）降低了手动取出导线所需的力（140 g±32.5对82 g±14.7，p = 0.03）。RV的死后分析显示形成了心外膜出血性病变，手动牵引和EE后也存在该病变。未出现心包积液、穿孔和室性心律失常。
在体外和体内模型中，将EE部位特异性递送至导线沿线暴露金属区域可降低取出导线所需的力。需要进一步研究以评估其在临床护理中的应用。
