Department of Cardiology, Tokyo Women's Medical University.
Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University.
Circ J. 2021 Jul 21;85(8):1349-1355. doi: 10.1253/circj.CJ-20-1199. Epub 2021 Apr 2.
The number of patients undergoing cardiac resynchronization therapy has increased. Consequently, there is increased frequency in the removal and reimplantation of coronary venous (CV) leads due to infection or malfunction.
A total of 345 consecutive patients referred for lead(s) extraction were reviewed. Of these, 34 patients who underwent a CV lead removal were investigated. The indications for CV leads removal were device-related infections in 29 patients and lead malfunctions in 5 patients. The average duration of the CV leads was 4.1±3.8 years. All CV leads were successfully removed without any major complications, except for 1 in-hospital death. Successful CV lead removal by simple traction (ST) was achieved in 21 patients (62%), whereas extraction tools were required in 13 patients (38%). Local infection and CV lead dwell time were significantly associated with successful ST (P=0.04 and P=0.014, respectively). CV lead re-implantation was successfully performed in 25 patients; however, a right-side approach was required in 92%, and occlusion/stenosis of the previous CV was observed in 80% of the patients.
CV lead removal is relatively successful and safe. The presence of local infection and a shorter lead duration may enable successful ST of a CV lead. However, the re-implantation procedure should be well prepared for the complexity related to the right-side approach and occlusion/stenosis of the previous CV.
接受心脏再同步治疗的患者数量有所增加。因此，由于感染或故障，冠状动脉（CV）导线的移除和重新植入的频率也有所增加。
共回顾了 345 例连续转诊进行导线拔除的患者。其中，对 34 例接受 CV 导线拔除的患者进行了调查。CV 导线拔除的指征为 29 例患者的器械相关感染和 5 例患者的导线故障。CV 导线的平均使用时间为 4.1±3.8 年。所有 CV 导线均成功拔除，无重大并发症，但有 1 例院内死亡。21 例患者（62%）通过简单牵引（ST）成功拔除 CV 导线，13 例患者（38%）需要使用拔除工具。局部感染和 CV 导线留置时间与 ST 的成功显著相关（P=0.04 和 P=0.014）。25 例患者成功进行了 CV 导线重新植入，但 92%的患者需要右侧入路，80%的患者观察到之前 CV 的闭塞/狭窄。
CV 导线的拔除相对较为成功且安全。局部感染和较短的导线留置时间可能有助于 CV 导线的 ST。然而，重新植入程序应充分准备好应对右侧入路和先前 CV 闭塞/狭窄相关的复杂性。
