Divisions of Cardiovascular Surgery and Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Divisions of Cardiovascular Surgery and Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Heart Rhythm. 2022 Jul;19(7):1097-1103. doi: 10.1016/j.hrthm.2021.10.019. Epub 2021 Oct 22.
Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized.
The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population.
We performed a retrospective multicenter study examining patients undergoing lead extraction at 8 Canadian institutions from 1996 through 2016. Demographic and clinical data were used to identify variables associated with perforation and mortality using logistic regression modeling.
A total of 2325 consecutive patients (age 61.9 ±16.5 years) underwent extraction of 4527 leads. Perforation rate was 2.7% (63/2325) and 30-day mortality was 1.6% (38/2325), with mortality of 0.4% due to perforation (10/2325). Variables associated with perforation included no previous cardiac surgery (odds ratio [OR] 3.33; 95% confidence interval [CI] 1.54-7.19; P = .002), female sex (OR 3.27; 95% CI 1.91-5.60; P <.001); left ventricular ejection fraction ≥40% (OR 2.81; 95% CI 1.28-6.14; P = .010); lead age >8 years (OR 2.64; 95% CI 1.52-4.60; P <.001); ≥2 leads extracted (OR 2.49; 95% CI 1.23-5.04; P = .011); and diabetes (OR 2.12; 95% CI 1.16-3.86; P = .014). Variables associated with death included infection as indication for extraction (OR 3.85; 95% CI 1.38-10.73; P = .010); anemia (OR 3.14; 95% CI 1.38-6.61; P = .003), and patient age (OR 1.04; 95% CI 1.01-1.07; P = .012).
Risk factors associated with perforation in lead extraction include no history of cardiac surgery, female sex, preserved left ventricular ejection fraction, lead age >8 years, ≥2 leads extracted, and diabetes.
经静脉的导联拔除术可能会出现严重的不良事件，例如心脏或血管穿孔。危险因素尚未得到很好的描述。
本研究的目的是确定与穿孔和死亡相关的因素，并对大量当代人群中的导联拔除术进行特征描述。
我们进行了一项回顾性多中心研究，该研究对 8 家加拿大机构 1996 年至 2016 年间进行的 2325 例连续患者进行了检查。使用逻辑回归模型，利用人口统计学和临床数据确定与穿孔和死亡率相关的变量。
共有 2325 例连续患者（年龄 61.9±16.5 岁）接受了 4527 个导联的拔除术。穿孔率为 2.7%（63/2325），30 天死亡率为 1.6%（38/2325），死亡率为 0.4%（10/2325）归因于穿孔。与穿孔相关的变量包括无既往心脏手术史（比值比 [OR] 3.33；95%置信区间 [CI] 1.54-7.19；P=.002），女性（OR 3.27；95%CI 1.91-5.60；P <.001）；左心室射血分数≥40%（OR 2.81；95%CI 1.28-6.14；P=.010）；导联年龄>8 年（OR 2.64；95%CI 1.52-4.60；P <.001）；≥2 个导联被拔除（OR 2.49；95%CI 1.23-5.04；P =.011）；以及糖尿病（OR 2.12；95%CI 1.16-3.86；P =.014）。与死亡相关的变量包括感染作为拔除术的指征（OR 3.85；95%CI 1.38-10.73；P=.010）；贫血（OR 3.14；95%CI 1.38-6.61；P=.003），和患者年龄（OR 1.04；95%CI 1.01-1.07；P=.012）。
与导联拔除术穿孔相关的危险因素包括无心脏手术史、女性、保留的左心室射血分数、导联年龄>8 年、≥2 个导联被拔除、以及糖尿病。
