Horlbeck Fritz W, Eckerth Christopher, Linhart Markus, Schaefer Christian, Jakob Mark, Pingel Simon, Klarmann-Schulz Ute, Nickenig Georg, Schwab Joerg O
Department of Medicine-Cardiology, University Hospital Bonn, Bonn, Germany.
Department of Medicine-Angiology, University Hospital Bonn, Bonn, Germany.
Pacing Clin Electrophysiol. 2021 Jun;44(6):1027-1032. doi: 10.1111/pace.14266. Epub 2021 May 24.
Very little is known about the long-term prevalence of severe venous obstruction and occlusion in patients with transvenous implantable cardioverter-defibrillator leads. The objective of the current investigation was to elucidate the incidence and prevalence and to identify predisposing conditions in an ICD cohort over a long follow-up period.
Based on a prospective database, we analyzed consecutive patients who received an ICD implantation in our hospital between 06/1988 and 2009 as well as all corresponding follow-up data until 02/2018. Cavographies were used for analysis, and all patients with at least one device replacement and one follow-up cavography were included.
Over a mean follow-up period of 94 ± 50 months, severe venous obstruction was found in 147 (33%) of 448 patients. Kaplan-Meier analysis shows a severe obstruction or occlusion in 50% of patients after a period of 14.3 years. The total number of leads (p < .001, HR 2.01, CI 2.000-2.022), an advanced age (p = .004, HR 1.023 per year, CI 1.022-1.024) and the presence of dilated cardiomyopathy (p = .035, HR 1.49, CI 1.47-1.51) were predictive of venous obstruction whereas the presence of anticoagulation was not.
Severe obstruction of the access veins after ICD implantation occurs frequently and its prevalence shows a nearly linear increase over long-time follow-up. Multiple leads, an advanced age and DCM as underlying disease are associated with an increased risk of venous obstruction while the role of anticoagulation to prevent venous obstruction in ICD patients is unclear.
对于经静脉植入式心律转复除颤器（ICD）导线患者中严重静脉阻塞和闭塞的长期患病率了解甚少。本研究的目的是阐明发病率和患病率，并确定在长期随访期间ICD队列中的易感因素。
基于前瞻性数据库，我们分析了1988年6月至2009年期间在我院接受ICD植入的连续患者，以及直至2018年2月的所有相应随访数据。采用腔静脉造影进行分析，纳入所有至少进行过一次设备更换和一次随访腔静脉造影的患者。
在平均94±50个月的随访期内，448例患者中有147例（33%）出现严重静脉阻塞。Kaplan-Meier分析显示，14.3年后50%的患者出现严重阻塞或闭塞。导线总数（p<0.001，HR 2.01，CI 2.000-2.022）、高龄（p = 0.004，每年HR 1.023，CI 1.022-1.024）和扩张型心肌病的存在（p = 0.035，HR 1.49，CI 1.47-1.51）是静脉阻塞的预测因素，而抗凝治疗的存在则不是。
ICD植入后通路静脉的严重阻塞经常发生，其患病率在长期随访中呈近似线性增加。多根导线、高龄和潜在疾病扩张型心肌病与静脉阻塞风险增加相关，而抗凝在预防ICD患者静脉阻塞中的作用尚不清楚。
