Regoli François, Auricchio Angelo, Di Cori Andrea, Segreti Luca, Blomström-Lunqvist Carina, Butter Christian, Deharo Jean-Claude, Kennergren Charles, Kutarski Andrzej, Laroche Cecile, Zalevskiy Valery, Luzzi Giovanni, Cano Oscar, Grabowski Marcin, Rinaldi Christopher, Bongiorni Maria Grazia
Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
J Cardiovasc Electrophysiol. 2019 Jul;30(7):1086-1095. doi: 10.1111/jce.13946. Epub 2019 Apr 29.
Little data are available on anticoagulation (AC) management in patients with cardiac resynchronization (CRT) devices who undergo transvenous lead extraction (TLE) procedure. We investigated the impact of AC on periprocedural complications in CRT patients undergoing TLE, enrolled in the ESC-EHRA European Lead Extraction ConTrolled (ELECTRa) registry.
All CRT patients treated with TLE enrolled in the registry were considered. Perioperative AC management was left to the discretion of the Center. Major and minor intraprocedural and postprocedural complications were compared between patients without AC (Gp1) and patients with AC (Gp2). Regression analyses were performed to identify predictors of complications for Gp2. Out of 734 CRT pts, 328 (44.7%) were under AC (Gp2). Patients from Gp2 presented lower LVEF (Gp2 32.5 ± 10.9 vs Gp1 34.5 ± 11.9%; P = 0.03), more advanced heart failure disease (NYHA III/IV: Gp2 42.0 vs Gp1 31.5%; P = 0.02), and renal impairment (Gp2 39.0 vs Gp1 24.3%; P < 0.001). Perioperative regimens included AC interruption (Gp2A: n = 169, 51.5%), "bridging" (Gp2B: n = 135, 41.2%), or continued AC (Gp2C: n = 24, 7.3%). TLE complete success rates (98% in both groups) and major complication rates were comparable for both groups; minor bleeding events were more frequent in Gp2 (5.5%) compared to Gp1 (2.5%; P = 0.051). No independent predictors were identified for Gp2, but minor complications were associated with "bridging" approach (Gp2B: 16 events vs Gp2A/C: 9 events; P = 0.020).
CRT patients treated with TLE under AC were more compromised but did not present more major complications compared to patients without AC. More minor complications were associated with "bridging" AC regimen.
关于接受经静脉导线拔除（TLE）手术的心脏再同步化治疗（CRT）装置患者的抗凝（AC）管理，目前可用数据较少。我们在ESC-EHRA欧洲导线拔除对照（ELECTRa）注册研究中，调查了AC对接受TLE的CRT患者围手术期并发症的影响。
纳入注册研究中所有接受TLE治疗的CRT患者。围手术期AC管理由各中心自行决定。比较了未接受AC治疗的患者（第1组）和接受AC治疗的患者（第2组）在手术中和术后的主要和次要并发症。进行回归分析以确定第2组并发症的预测因素。在734例CRT患者中，328例（44.7%）接受了AC治疗（第2组）。第2组患者的左心室射血分数较低（第2组为32.5±10.9%，第1组为34.5±11.9%；P=0.03），心力衰竭病情更严重（纽约心脏病协会III/IV级：第2组为42.0，第1组为31.5%；P=0.02），且肾功能损害发生率更高（第2组为39.0，第1组为24.3%；P<0.001）。围手术期方案包括AC中断（第2A组：n=169，51.5%）、“桥接”（第2B组：n=135，41.2%）或继续AC治疗（第2C组：n=24，7.3%）。两组的TLE完全成功率（均为98%）和主要并发症发生率相当；第2组的轻微出血事件发生率（5.5%）高于第1组（2.5%；P=0.051）。未确定第2组的独立预测因素，但轻微并发症与“桥接”方法相关（第2B组：16例事件，第2A/C组：9例事件；P=0.020）。
与未接受AC治疗的患者相比，接受AC治疗的TLE CRT患者病情更严重，但主要并发症并未更多。更多轻微并发症与“桥接”AC方案相关。
