Keiler Jonas, Schulze Marko, Dreger Ronja, Springer Armin, Öner Alper, Wree Andreas
Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany.
Front Cardiovasc Med. 2020 Nov 30;7:602179. doi: 10.3389/fcvm.2020.602179. eCollection 2020.
The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1-2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.
用于心律失常治疗的心脏植入式电子设备的需求仍然有增无减。尽管不断进行优化，但诸如感染或断裂等与导线相关的问题常常需要进行导线拔除。由于存在粘性血栓 - 纤维化导线包封（TFLE），经静脉导线拔除具有挑战性且风险较大。然而，关于TFLE以及与导线技术参数和植入时间（DT）之间可能的相关性，迄今研究尚不充分。因此，我们分析了来自35具尸体供体的62根导线的TFLE，以获取潜在导线设计优化的信息。我们通过组织学石蜡切片和脱细胞样本的扫描电子显微镜，基于解剖标志检查了TFLE的地形以及组织形态学TFLE特征。宏观分析显示，所有导线均受到TFLE的影响，主要在导线所在的静脉中。一半（47.2%）的右心室导线与三尖瓣有粘连。平均而言，血管内导线长度的49.9±21.8%被TFLE覆盖，其中82.8±16.2%是粘性壁粘连（WB）。具有至少一个WB部分的离散TFLE的平均长度为95.0±64.3毫米，最长为200毫米。性别、DT以及某些导线技术参数均未显示出促进或预防TFLE的明显趋势。TFLE的形成似乎在植入后的前1 - 2周内就早早开始。TFLE的纤维化程度从血栓开始，由致密胶原纤维的数量反映，同样在很大程度上与DT无关。TFLE厚度常常达到数百微米。偶尔可见钙化，且沿TFLE鞘不规则出现。无导线起搏器系统具有克服TFLE问题的优势，但也有其自身特定的风险和局限性，目前尚未完全明确。
