Regoli François, D'Ambrosio Gabriele, Caputo Maria Luce, Svab Stefano, Conte Giulio, Moccetti Tiziano, Klersy Catherine, Cassina Tiziano, Demertzis Stefanos, Auricchio Angelo
Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900, Lugano, Switzerland.
Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy.
J Interv Card Electrophysiol. 2018 Apr;51(3):253-261. doi: 10.1007/s10840-018-0327-1. Epub 2018 Feb 23.
Pericardial effusion (PE) may occur during the lead extraction procedure (TLE). Little is known about the incidence, causes, and predictors of this complication.
From January 2009 to October 2016, TLE was attempted for 297 leads in 212 patients (age 69.3 ± 12.9 years, 169 male, BMI 27.2 ± 9.9 m²/kg, LVEF 43.4 ± 24.6%) for lead dysfunction (62.7%), upgrade (16.0%), infection (14.2%), or other (7.0%) indications. TLE was performed under general anesthesia with continuous invasive arterial blood pressure and transesophageal echocardiography (TEE) monitoring. For lead removal, the mechanical approach was first attempted, followed by the laser-assisted technique when needed. Severity of PE was defined by the presence of hemodynamically significant PE > 10 mm at TEE.
Clinical success was achieved for 292 leads (98.3%). New-onset PE was observed in 14 patients (6.6%) [mild entity in 7 patients (3.3%) and severe in 7 (3.3%)]. In these latter patients, intra-procedural management included surgery (n = 3), pericardiocentesis (n = 2), or a conservative approach (n = 2). Right ventricular (RV) site lesions were treated with a simple fluid infusion. Laceration of the superior vena cava and other vessels resulted in rescue surgery. Lesions of the right atrial free wall (n = 1) and coronary sinus (n = 1) were treated with pericardiocentesis. NYHA III/IV, LVEF < 35%, renal impairment, right-sided implant, and ≥2 leads targeted for TLE were associated with new-onset PE. More than two factors identified a higher risk group (16.2%, 95% CI 6.2-32.0%, P = 0.02).
New-onset PE is common during TLE and is associated with specific factors. PE severity and subsequent patient management depend on the site of injury.
心包积液（PE）可能在导线拔除术（TLE）过程中发生。关于这一并发症的发生率、原因和预测因素知之甚少。
2009年1月至2016年10月，对212例患者（年龄69.3±12.9岁，男性169例，BMI 27.2±9.9m²/kg，左心室射血分数[LVEF]43.4±24.6%）的297根导线进行了TLE尝试，导线功能障碍（62.7%）、升级（16.0%）、感染（14.2%）或其他（7.0%）为适应证。TLE在全身麻醉下进行，持续有创动脉血压和经食管超声心动图（TEE）监测。对于导线拔除，首先尝试机械方法，必要时采用激光辅助技术。PE的严重程度根据TEE显示存在血流动力学显著意义的PE>10mm来定义。
292根导线（98.3%）获得临床成功。14例患者（6.6%）出现新发PE[7例（3.3%）为轻度，7例（3.3%）为重度]。在这些患者中，术中处理包括手术（n = 3）、心包穿刺术（n = 2）或保守治疗（n = 2）。右心室（RV）部位损伤采用单纯补液治疗。上腔静脉和其他血管撕裂导致补救性手术。右心房游离壁损伤（n = 1）和冠状静脉窦损伤（n = 1）采用心包穿刺术治疗。纽约心脏协会（NYHA）III/IV级、LVEF<35%、肾功能损害、右侧植入以及≥2根导线作为TLE目标与新发PE相关。超过两个因素确定为高危组（16.2%，95%CI 6.2 - 32.0%，P = 0.02）。
新发PE在TLE期间很常见，且与特定因素相关。PE的严重程度及随后的患者处理取决于损伤部位。
