Fanous Yehia, Gula Lorne, Skanes Allan, Tang Anthony, Yee Raymond, Khan Habib R
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
CJC Open. 2021 Aug 10;3(12):1490-1494. doi: 10.1016/j.cjco.2021.07.019. eCollection 2021 Dec.
Cardiac implantable electronic devices deliver life-sustaining therapy and may be prone to hardware degeneration over time. Functioning transvenous endocardial leads with visible insulation breaks are amenable to lead revision (LRV) or lead repair (LRP), with medical adhesive. The latter is a less invasive and more cost-effective strategy. However, data are sparse on the overall safety of such an approach.
This is a retrospective cohort study of patients with lead insulation defects managed by either LRV or LRP with medical adhesive. The data analyzed were from January 2010 to January 2021. All-cause mortality, and both early and late complications, was ascertained for all cases.
A total of 57 cases were identified, with a mean age (standard deviation) of 75 (±11.8) years; 18 (31.6%) were women. A total of 35 patients (62.5%) underwent LRV for an insulation defect, and 21 (37.5%) underwent LRP. There was no statistical difference in the rate of early and late complications between the 2 groups over a mean follow-up period of 1.15 (±0.78) years [3 (8%)] LRV vs 1 (5%) LRP, = 0.88) One death was identified in each group, unrelated to either the device or a device-related procedure. There was no association between device type and the likelihood of LRP vs LRV as an attempted strategy (χ = 2.25, = 0.53).
The results of this study suggest that the use of a lead-repair strategy, with silicone adhesive glue and an anchoring sleeve, is not associated with an increased rate of early or late complications, compared with lead revision in the management of visible lead insulation defects with stable lead function.
心脏植入式电子设备提供维持生命的治疗，随着时间的推移可能容易出现硬件退化。具有可见绝缘破损的功能性经静脉心内膜导线适合进行导线翻修（LRV）或使用医用粘合剂进行导线修复（LRP）。后者是一种侵入性较小且成本效益更高的策略。然而，关于这种方法的整体安全性的数据很少。
这是一项对采用LRV或使用医用粘合剂进行LRP治疗的导线绝缘缺陷患者的回顾性队列研究。分析的数据来自2010年1月至2021年1月。确定了所有病例的全因死亡率以及早期和晚期并发症。
共识别出57例病例，平均年龄（标准差）为75（±11.8）岁；18例（31.6%）为女性。共有35例患者（62.5%）因绝缘缺陷接受了LRV，21例（37.5%）接受了LRP。在平均1.15（±0.78）年的随访期内，两组的早期和晚期并发症发生率无统计学差异[LRV组为3例（8%），LRP组为1例（5%），P = 0.88]。每组均有1例死亡，与设备或与设备相关的操作无关。作为一种尝试的策略，设备类型与LRP和LRV的可能性之间没有关联（χ² = 2.25，P = 0.53）。
本研究结果表明，在管理具有稳定导线功能的可见导线绝缘缺陷时，与导线翻修相比，使用带有硅酮粘合剂胶水和锚定套管的导线修复策略不会增加早期或晚期并发症的发生率。
