Division of Cardiology, Department of Internal Medicine, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
J Cardiovasc Med (Hagerstown). 2019 Jun;20(6):372-378. doi: 10.2459/JCM.0000000000000797.
Finding of intracardiac lead masses in patients with cardiac implantable electronic devices remains controversial, as such masses have been observed in cases of exclusively local infections whereas they have not been recognized in patients with positive cultures of intravascular lead fragments. In this study, we aim to describe the prevalence of intracardiac lead masses in true asymptomatic patients with cardiac implantable electronic devices, to identify their predictive factors and to define their prognostic impact at long-term follow-up.
Seventy-eight consecutive patients admitted over a 6-month period for elective generator replacement without clinical evidence of infection were evaluated by transthoracic and transesophageal echocardiography and prospectively followed at in-clinic follow-up visits.
Lead masses were found in 10 patients (12.8%). These patients had more frequently right ventricular dysfunction at univariate analysis (OR 2.71, P = 0.010) and after baseline variables adjustment (hazard ratio 6.25, P = 0.012). At 5-year follow-up without any specific therapy, none of the patients suffered from any cardiac device infections, or developed clinical signs of infections.
There is an evidence of clinical lead masses in asymptomatic patients with cardiac implantable electronic devices. The value of these findings is still debated for aetiological interpretation and for therapeutic strategy, but they are not necessarily associated with an infection.
在患有心脏植入式电子设备的患者中发现心内导线肿块仍然存在争议，因为这种肿块仅在局部感染的情况下观察到，而在血管内导线碎片培养阳性的患者中未发现。在这项研究中，我们旨在描述真正无症状的患有心脏植入式电子设备的患者中心内导线肿块的患病率，确定其预测因素，并定义其在长期随访中的预后影响。
在 6 个月的时间内，连续有 78 例因选择性发电机更换而入院的患者，无感染的临床证据，通过经胸和经食管超声心动图进行评估，并在门诊随访中进行前瞻性随访。
10 例患者（12.8%）发现导线肿块。在单变量分析中（OR 2.71，P = 0.010）和在基线变量调整后（风险比 6.25，P = 0.012），这些患者更频繁地出现右心室功能障碍。在没有任何特定治疗的 5 年随访中，没有患者发生任何心脏设备感染或出现感染的临床迹象。
在无症状的患有心脏植入式电子设备的患者中存在临床导线肿块的证据。这些发现的价值对于病因学解释和治疗策略仍然存在争议，但它们不一定与感染有关。
