Epstein Laurence M, Maytin Melanie
Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
J Innov Card Rhythm Manag. 2017 May 15;8(5):2702-2716. doi: 10.19102/icrm.2017.080502. eCollection 2017 May.
Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis. The past four decades, however, have witnessed significant advances in lead extraction technology, resulting in more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a marked decline in the incidence of procedure-related morbidity and mortality, with recent registries at high-volume centers reporting high success rates with exceedingly low complication rates. Future developments in lead extraction are likely to focus on new tools that will allow for us to provide comprehensive device management, develop alternative systems for extraction training, and focus on the design of new leads conceived to facilitate future extraction.
自经静脉导线拔除术（TLE）作为一种技术有限、治疗选择受限的基本技能诞生以来，它经历了迅猛的发展。早期技术包括简单的手动牵引，但这种方法对于长期植入的导线往往效果不佳，并且存在心肌撕裂、心包填塞和死亡的重大风险。与这些早期拔除技术相关的发病率和死亡率限制了它们仅用于危及生命的情况，如感染和脓毒症。然而，在过去的四十年里，导线拔除技术取得了显著进展，产生了更有效的技术和工具，为技术娴熟的拔除者提供了一套装备精良的器械库。随着该学科的发展，我们见证了TLE专家群体的壮大，与此同时，与手术相关的发病率和死亡率显著下降，近期大容量中心的登记数据显示成功率高且并发症发生率极低。导线拔除术未来的发展可能会集中在新工具上，这些新工具将使我们能够提供全面的设备管理，开发拔除培训的替代系统，并专注于设计便于未来拔除的新型导线。
