Mayo Clinic Arizona, Phoenix, Arizona.
Mayo Clinic Health System, Mankato, Minnesota.
Heart Rhythm. 2018 Nov;15(11):1593-1600. doi: 10.1016/j.hrthm.2018.08.008.
Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR).
The purpose of this study was to examine stroke and its associated factors in patients undergoing TLR for CIED infection.
We performed a retrospective analysis of all patients undergoing TLR for CIED infection from January 1, 2000, to July 30, 2017, from all 3 tertiary referral centers at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). The primary outcome was stroke and was further categorized into preprocedural and postprocedural stroke. Associated risk factors were analyzed.
A total of 774 patients (mean age 67.6 ± 14.9 years) underwent TLR for CIED infection. The stroke rate in this cohort was 1.9% (95% confidence interval [CI] 1.1%-3.2%). The preprocedural and postprocedural stroke rate was 0.9% (95% CI 0.4%-1.9%) and 1.0% (95% CI 0.4%-2.0%), respectively. PFOs were identified in 46.7% of patients with stroke and in 12.9% of patients without stroke, and were independently associated with stroke (P = .0002). This was especially in patients with right-sided vegetations with right-to-left shunting (odds ratio 6.4; 95% CI 1.3-31.0; P = .022).
In patients with CIED infection undergoing TLR, the presence of PFO, especially with right-sided vegetation with right-to-left shunting, was associated with an increased risk of stroke. This finding suggests that PFO screening before TLR warrants meticulous attention.
在患有心血管植入式电子设备（CIED）感染的患者中，中风可能是一种毁灭性的并发症。在经静脉导线移除（TLR）过程中，由于栓塞物脱落，心内直视术后的反常性感染性栓子栓塞可能会发生在设备导联和卵圆孔未闭（PFO）同时存在的情况下。
本研究旨在探讨经 TLRS 治疗 CIED 感染患者中风及其相关因素。
我们对 2000 年 1 月 1 日至 2017 年 7 月 30 日期间，梅奥诊所（罗切斯特、凤凰城和杰克逊维尔）的所有 3 个三级转诊中心因 CIED 感染而行 TLR 的所有患者进行了回顾性分析。主要结局是中风，并进一步分为术前和术后中风。分析了相关的危险因素。
共有 774 例患者（平均年龄 67.6 ± 14.9 岁）因 CIED 感染而行 TLR。该队列的中风发生率为 1.9%（95%置信区间[CI]1.1%-3.2%）。术前和术后中风发生率分别为 0.9%（95%CI0.4%-1.9%）和 1.0%（95%CI0.4%-2.0%）。有中风的患者中 46.7%存在 PFO，而无中风的患者中为 12.9%，PFO 与中风独立相关（P=0.0002）。特别是在有右心感染性赘生物合并右向左分流的患者中（优势比 6.4；95%CI1.3-31.0；P=0.022）。
在因 CIED 感染而行 TLR 的患者中，PFO 的存在，特别是伴有右心感染性赘生物合并右向左分流的 PFO，与中风风险增加相关。这一发现表明，在进行 TLR 之前，PFO 的筛查需要格外注意。
