Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands.
Pacing Clin Electrophysiol. 2022 Jan;45(1):132-140. doi: 10.1111/pace.14416. Epub 2021 Dec 16.
Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV-lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV-lead extraction requiring dissection up to the myocardium.
From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand-powered mechanical Evolution system to extract RV-leads (n = 185) were examined from a prospective registry. We assessed 4 groups: TLE with the first generation Evolution (n = 43) with (A1,n = 18) and without (A2,n = 25) adhesions up to the myocardium and TLE with the Novel R/L type (n = 142) of sheath with (B1, n = 59) and without (B2, n = 83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p = 0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p = 0.0067). There were no deaths. Overall major complication rates were low (2/185; 1.1%) and there was no statistically significant difference in major and minor complications between the two groups.
Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.
经静脉导线拔除术（TLE）的目标是完整地移除所有目标导线，且无并发症。尽管采取了反向牵引操作，但由于右心室导线（RV 导线）尖端断裂，疗效往往受到阻碍。机械动力导线拔除（Evolution 鞘）是有效的，然而，直至导线尖端的分离安全性尚不清楚。因此，我们研究了需要直至心肌分离才能拔除 RV 导线的 RV 导线拔除的可行性和安全性。
2009 年至 2018 年，从前瞻性登记处检查了伊萨拉心脏中心（荷兰兹沃勒）所有需要手动机械 Evolution 系统拔除 RV 导线的 TLE（n = 185）。我们评估了 4 组：第一代 Evolution 的 TLE（n = 43），其中有（A1，n = 18）和没有（A2，n = 25）到达心肌的粘连；以及新型 R/L 型（n = 142）的 Novel R/L 型鞘，其中有（B1，n = 59）和没有（B2，n = 83）到达心肌的粘连。B 组的完全成功率明显高于 A 组（96.5%比 76.7%，p = 0.0354）。当比较到达心肌的粘连患者时，R/L 组的总完全成功率更高（61.1%比 90.5%，p = 0.0067）。无死亡病例。总体主要并发症发生率较低（185 例中有 2 例；1.1%），两组之间主要和次要并发症无统计学显著差异。
对于到达心肌的 RV 导线，使用双向 Evolution R/L 鞘的拔除策略是安全可行的。
