Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands.
Europace. 2019 Sep 1;21(9):1378-1384. doi: 10.1093/europace/euz197.
Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection.
All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6-38.2) and 11.6 (5.6-17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration.
Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.
废弃导联常与导联拔除过程中的并发症相关，因此如果导联功能丧失，应预防性拔除。我们研究了在因器械相关感染而拔除这些导联时，它们对并发症的影响。
纳入我院 2006 年至 2017 年间因器械相关感染而行导联拔除的所有患者。主要终点为主要并发症。500 例患者中，141 例有废弃导联，其中 75%仅有 1 条废弃导联。有或无废弃导联的患者中位累计植入时间分别为 24.2（15.6-38.2）和 11.6（5.6-17.4）年。50.4%的患者仅经股静脉入路拔除所有导联，22.2%的患者采用机械旋转工具，5%的患者采用替代激光鞘。废弃导联组有 0.7%的患者发生主要并发症，而仅有活性导联的患者为 1.7%（P=0.679）。有或无废弃导联的患者中，未能完全拔除所有导联的比例分别为 14.9%和 6.4%（P=0.003），临床失败的比例分别为 6.4%和 2.2%（P=0.028）。采用机械旋转工具后，程序失败分别降至 9.2%和 5.7%（P=0.37）。多变量分析中，程序和临床失败的唯一独立预测因素是累计植入时间。
尽管植入时间较长，但废弃导联患者在拔除导联时并未发生更多的主要并发症。因此，为避免后期并发症而预防性拔除功能丧失的导联并无必要。
