D'Angelo Giuseppe, Zweiker David, Fierro Nicolai, Marzi Alessandra, Paglino Gabriele, Gulletta Simone, Matta Mario, Melillo Francesco, Bisceglia Caterina, Limite Luca Rosario, Cireddu Manuela, Vergara Pasquale, Bosica Francesco, Falasconi Giulio, Pannone Luigi, Brugliera Luigia, Oloriz Teresa, Sala Simone, Radinovic Andrea, Baratto Francesca, Malatino Lorenzo, Peretto Giovanni, Nakajima Kenzaburo, Spartalis Michael D, Frontera Antonio, Della Bella Paolo, Mazzone Patrizio
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy.
Third Clinical Department for Cardiology and Intensive Care, Klinik Ottakring, 1160 Vienna, Austria.
J Clin Med. 2021 Sep 7;10(18):4043. doi: 10.3390/jcm10184043.
after transvenous lead extraction (TLE) of cardiac implantable electric devices (CIEDs), some patients may not benefit from device reimplantation. This study sought to analyse predictors and long-term outcome of patients after TLE with vs. without reimplantation in a high-volume centre.
all patients undergoing TLE at our centre between January 2010 and November 2015 were included into this analysis.
a total of 223 patients (median age 70 years, 22.0% female) were included into the study. Cardiac resynchronization therapy-defibrillator (CRT-D) was the most common device (40.4%) followed by pacemaker (PM) (31.4%), implantable cardioverter-defibrillator (ICD) (26.9%), and cardiac resynchronization therapy-PM (CRT-P) (1.4%). TLE was performed due to infection (55.6%), malfunction (35.9%), system upgrade (6.7%) or other causes (1.8%). In 14.8%, no reimplantation was performed after TLE. At a median follow-up of 41 months, no preventable arrhythmia-related events were documented in the no-reimplantation group, but 11.8% received a new CIED after 17-84 months. While there was no difference in short-term survival, five-year survival was significantly lower in the no-reimplantation group (78.3% vs. 94.7%, = 0.014).
in patients undergoing TLE, a re-evaluation of the indication for reimplantation is safe and effective. Reimplantation was not related to preventable arrhythmia events, but all-cause survival was lower.
在经静脉取出心脏植入式电子设备（CIED）后，部分患者可能无法从设备重新植入中获益。本研究旨在分析在一个高容量中心中，经静脉取出设备后进行与未进行重新植入的患者的预测因素及长期预后。
纳入2010年1月至2015年11月在本中心接受经静脉取出设备的所有患者进行分析。
共223例患者（中位年龄70岁，22.0%为女性）纳入研究。心脏再同步化治疗除颤器（CRT-D）是最常见的设备（40.4%），其次是起搏器（PM）（31.4%）、植入式心律转复除颤器（ICD）（26.9%）和心脏再同步化治疗起搏器（CRT-P）（1.4%）。经静脉取出设备的原因包括感染（55.6%）、故障（35.9%）、系统升级（6.7%）或其他原因（1.8%）。14.8%的患者在经静脉取出设备后未进行重新植入。中位随访41个月时，未重新植入组未记录到可预防的心律失常相关事件，但11.8%的患者在17 - 84个月后接受了新的CIED。虽然短期生存率无差异，但未重新植入组的五年生存率显著较低（78.3%对94.7%，P = 0.014）。
在接受经静脉取出设备的患者中，重新评估重新植入的适应证是安全有效的。重新植入与可预防的心律失常事件无关，但全因生存率较低。
