Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Department of Cardiology, Azienda Ospedaliero-Universitaria, Pisa, Italy.
Europace. 2022 May 3;24(5):817-827. doi: 10.1093/europace/euab240.
The aims of this study is to characterize the transvenous lead extraction (TLE) population with active (A) compared with passive fixation (PFix) leads and to compare the safety, efficacy, and ease of extracting active fixation (AFix) compared with PFix right atrial (RA) and right ventricular (RV) leads.
The European Lead Extraction ConTRolled Registry (ELECTRa) was analysed. Patients were divided into three groups; those with only AFix, only PFix, and combined Fix leads. Three outcomes were defined. Difficult extraction, complete radiological, and clinical success. Multivariate model was used to analyse the independent effect of Fix mechanism on these outcomes. The study included 2815 patients, 1456 (51.7%) with only AFix leads, 982 (34.9%) with only PFix leads, and 377 (13.4%) with combined Fix leads. Patients with AFix leads were younger with shorter lead dwelling time. Infection was the leading cause for TLE among the combined Fix group with lowest rates among AFix group. No difference in complications rates was noted between patients with only AFix vs. PFix leads. Overall, there were 1689 RA (1046 AFix and 643 PFix) and 2617 RV leads (1441 AFix and 1176 PFix). Multivariate model demonstrated that PFix is independently associated with more difficult extraction for both RA and RV leads, lower radiological success in the RA but has no effect on clinical success.
Mechanism of Fix impact the ease of TLE of RA and RV leads and rates of complete radiological success in the RA but not clinical success. These findings should be considered during implantation and TLE procedures.
本研究旨在描述主动固定（AFix）与被动固定（PFix）经静脉心脏起搏器（ICD）电极导线拔除（TLE）人群的特点，并比较 AFix 与 PFix 右心房（RA）和右心室（RV）电极导线 TLE 的安全性、有效性和难易程度。
分析了欧洲心脏起搏器（ICD）电极导线拔除注册研究（ELECTRa）。将患者分为三组：仅 AFix 组、仅 PFix 组和联合固定组。定义了三个结果：拔除困难、完全影像学和临床成功。采用多变量模型分析固定机制对这些结果的独立影响。研究共纳入 2815 例患者，其中仅 AFix 导线 1456 例（51.7%），仅 PFix 导线 982 例（34.9%），联合固定导线 377 例（13.4%）。AFix 导线组患者年龄较小，导线留置时间较短。感染是联合固定组 TLE 的主要原因，而 AFix 组的感染率最低。仅 AFix 组与仅 PFix 组的并发症发生率无差异。共有 1689 根 RA（1046 根 AFix 和 643 根 PFix）和 2617 根 RV 导线（1441 根 AFix 和 1176 根 PFix）。多变量模型显示，PFix 与 RA 和 RV 导线拔除困难、RA 影像学成功率较低独立相关，但对临床成功率无影响。
固定机制影响 RA 和 RV 导线 TLE 的难易程度以及 RA 影像学成功率的完全程度，但不影响临床成功率。在植入和 TLE 手术中应考虑这些发现。
