le Polain de Waroux Jean-Benoît, Scavée Christophe, Marchandise Sébastien
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate, Brussels, Belgium.
Eur Heart J Case Rep. 2018 May 4;2(2):yty056. doi: 10.1093/ehjcr/yty056. eCollection 2018 Jun.
Narrow calibre ICD leads are prone to present insulation defects and conductor externalization. Close follow-up of these leads is recommended but as long as their electrical function is maintained, no prophyllactic replacement or extraction is advised. Although the risk of thrombus formation involving externalized conductors has been described, this risk seems considered as negligible compared with the risk of a prophylactic lead extraction. However, when an intracavitar thrombus is identified, the safest therapeutic approach remains undetermined.
In the present clinical vignette, we describe the case of a giant thrombus developed along the externalized portion of an electrically functional ICD lead. In this case, the thrombus was successfully treated with a systemic oral anticoagulation.
This case report supports the concept of a prolonged anticoagulation for both the diagnosis and the long-term treatment of thrombus developed along externalized ICD leads, in particular when the patient prefers to avoid or postpone the risk of a trans-venous lead extraction.
窄口径植入式心律转复除颤器（ICD）导线容易出现绝缘缺陷和导线外露。建议对这些导线进行密切随访，但只要其电功能得以维持，不建议进行预防性更换或拔除。尽管已经描述了涉及外露导线形成血栓的风险，但与预防性导线拔除的风险相比，这种风险似乎被认为可以忽略不计。然而，当发现心腔内血栓时，最安全的治疗方法仍未确定。
在本临床案例中，我们描述了一例沿仍具有电功能的ICD导线外露部分形成巨大血栓的病例。在该病例中，通过全身性口服抗凝治疗成功治疗了血栓。
本病例报告支持对沿外露ICD导线形成的血栓进行长期抗凝治疗的理念，无论是用于诊断还是长期治疗，特别是当患者倾向于避免或推迟经静脉导线拔除的风险时。
