Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
Heart Rhythm. 2021 Mar;18(3):392-398. doi: 10.1016/j.hrthm.2020.11.012. Epub 2020 Nov 17.
There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome.
We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome.
We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome. Patient characteristics, extraction details, percutaneous management of SVC occlusions, and clinical follow up data were analyzed.
Over a 14-year period, more than 1600 TLEs were performed. Of these, 16 patients underwent TLE for symptomatic SVC syndrome. The mean age was 53.1 ± 12.8 years, and 9 (56.3%) were men. Thirty-seven leads, with a mean dwell time of 5.8 years (range 2-12 years), were extracted. After extraction, 6 patients (37.5%) received an SVC stent. Balloon angioplasty was performed before stenting in 5 cases (31.3%). There was 1 major complication (6.3%) due to an SVC tear that was managed surgically with a favorable outcome. Eleven patients underwent reimplantation of a CIED. Over a median follow-up of 5.5 years (interquartile range 2.0-8.5 years), 12 patients (75%) remained free of symptoms.
Combining TLE with the percutaneous treatment of symptomatic SVC syndrome is a safe and viable treatment strategy.
目前对于心血管植入式电子设备（CIED）相关上腔静脉（SVC）综合征的最佳治疗方法尚无共识。
我们报告了在有症状的 CIED 相关 SVC 综合征患者中经静脉导线拔除术（TLE）的经验。
我们回顾了一家高容量中心在 14 年期间进行的所有 TLE，并确定了因 SVC 综合征症状而行 TLE 的患者。分析了患者特征、拔除细节、SVC 闭塞的经皮处理以及临床随访数据。
在 14 年期间，进行了超过 1600 次 TLE。其中，16 例因 SVC 综合征症状而行 TLE。平均年龄为 53.1±12.8 岁，9 例（56.3%）为男性。拔除了 37 根导线，平均留置时间为 5.8 年（范围 2-12 年）。拔除后，6 例（37.5%）患者接受了 SVC 支架治疗。在支架植入前，有 5 例（31.3%）患者进行了球囊血管成形术。有 1 例（6.3%）严重并发症，即 SVC 撕裂，经手术治疗后预后良好。11 例患者接受了 CIED 的重新植入。在中位数为 5.5 年（四分位间距 2.0-8.5 年）的随访中，12 例（75%）患者无症状。
将 TLE 与 SVC 综合征的经皮治疗相结合是一种安全可行的治疗策略。
