Department of Cardiac Electrophysiology, Prairie Heart Institute, Springfield, Illinois, USA.
J Cardiovasc Electrophysiol. 2021 Nov;32(11):3042-3048. doi: 10.1111/jce.15229. Epub 2021 Sep 5.
In patients undergoing transvenous lead extraction (TLE), lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications.
The aim of this study was to evaluate the safety and effectiveness of TLE in patients with pacemaker or ICD leads with a dwell time of ≥20 years.
This is a single-center retrospective study of all patients who underwent TLE of at least 1 pacemaker or ICD leads a dwell time of ≥20 years.
During the study period, 124 patients were included in this analysis (50.8% female, mean age: 74.6 ± 10.7 years). Device-related infection was the most common (92.7%) indication for TLE. Extraction was attempted for a total 313 leads, of which 182 leads had dwell times ≥20 years (median: 276 months; interquartile range: 255-300 months). Complete procedural success was achieved in 112/124 patients (90.3%), and clinical success in 119/124 patients (96.0%). Complete removal was achieved for 294 leads (93.9%), partial removal in 10 leads, and failure in 9 leads. Clinical success (combined complete and partial success) rates were higher for leads with dwell times <20 years compared to older leads (99.2% vs. 95.6%, p = .017). Major procedural complications (including 1 death) occurred in 7/124 patients (5.6%). Minor complications were observed in 8 patients (6.5%).
TLE of very old (≥20 years) leads can be performed with reasonable success and safety when conducted at centers with expertise in lead management.
在接受经静脉导线拔除术（TLE）的患者中，导线留置时间已被认为是拔除失败和与手术相关并发症的危险因素。
本研究旨在评估在起搏器或 ICD 导线留置时间≥20 年的患者中进行 TLE 的安全性和有效性。
这是一项对至少 1 根起搏器或 ICD 导线留置时间≥20 年的所有患者进行 TLE 的单中心回顾性研究。
在研究期间，共有 124 例患者纳入本分析（50.8%为女性，平均年龄：74.6±10.7 岁）。器械相关感染是最常见（92.7%）的 TLE 适应证。总共尝试拔除 313 根导线，其中 182 根导线留置时间≥20 年（中位数：276 个月；四分位距：255-300 个月）。124 例患者中 112 例（90.3%）达到完全手术成功，124 例患者中 119 例（96.0%）达到临床成功。294 根导线（93.9%）完全拔除，10 根导线部分拔除，9 根导线拔除失败。与较老的导线相比，留置时间<20 年的导线的临床成功（完全和部分成功的总和）率更高（99.2%比 95.6%，p=0.017）。7/124 例患者（5.6%）发生主要手术并发症（包括 1 例死亡）。8 例患者（6.5%）出现轻微并发症。
在具有导线管理专业知识的中心进行操作时，对于非常陈旧（≥20 年）的导线，TLE 可以获得合理的成功率和安全性。
