Norton Caleb, Holmes Benjamin, Al Aboud Asad, Kim Eun-Jeong, Gonzales Holly, Ellis Christopher, John Roy, Crossley George H, Montgomery Jay
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Case Rep Cardiol. 2019 Jan 3;2019:6270950. doi: 10.1155/2019/6270950. eCollection 2019.
There is an increasing prevalence of cardiac implantable electronic devices (CIEDs) due to expanding adoption and availability of these evidence-based therapies. With the increased prevalence of these life-saving devices, there has also been an increased demand for lead removal and lead extraction. Understanding the specific subgroups of patients at high risk for complications during and after lead extraction has become imperative to properly manage endovascular CIED leads. There have been multiple published studies describing clinical variables that predict adverse outcomes in CIED system extractions; however, the risk of complications in leads placed after cardiac transplantation has not specifically been addressed to date. We present four cases of transvenous extraction and removal of pacing leads placed after cardiac transplantation. There were no major complications related to extraction in these four cases; however, three of the four patients died within one year after the procedure. While the etiology of death in these cases seemed to be unrelated to the extraction procedure, the indications for extraction (infection in the setting of immunosuppression and calcineurin-associated ESRD and poor sensing/capture possibly secondary to chronic rejection and/or frequent right heart biopsies) likely contributed at least indirectly to the subsequent death.
由于这些循证疗法的应用范围不断扩大且可及性提高，心脏植入式电子设备（CIED）的患病率日益上升。随着这些救生设备的患病率增加，对导线移除和拔除的需求也有所增加。了解在导线拔除期间及之后发生并发症的高风险患者的特定亚组，对于妥善管理血管内CIED导线至关重要。已有多项发表的研究描述了预测CIED系统拔除不良结局的临床变量；然而，心脏移植后植入导线的并发症风险迄今尚未得到专门探讨。我们报告了4例心脏移植后经静脉拔除起搏导线的病例。这4例病例中均未发生与拔除相关的重大并发症；然而，4例患者中有3例在术后1年内死亡。虽然这些病例的死亡原因似乎与拔除手术无关，但拔除的指征（免疫抑制和钙调神经磷酸酶相关的终末期肾病背景下的感染，以及可能继发于慢性排斥反应和/或频繁右心活检的感知/夺获不良）可能至少间接导致了随后的死亡。
