Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
Heart Rhythm. 2022 Jul;19(7):1104-1108. doi: 10.1016/j.hrthm.2022.02.024. Epub 2022 Mar 1.
Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique that incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein.
We sought to evaluate the safety and efficacy of a tandem femoral-superior approach to lead extraction.
Consecutive patients undergoing transvenous extraction of at least 1 pacemaker or defibrillator lead with implant duration ≥1 year in which a tandem femoral-superior technique was used as the initial extraction strategy were included. The registry spanned 2010-2018 and consisted of procedures performed by a single primary operator.
A total of 131 patients were included. A total of 267 leads with a mean implant duration of 9.8 years, including 90 defibrillator leads (33.7%), were targeted for extraction. No superior vena cava perforation or other vascular damage occurred. Clinical procedural success was achieved in 96.2% of cases. There were 5 major complications (3.8% of patients), with 3 being pericardial effusion requiring intervention. There were no deaths.
A tandem femoral-superior approach to lead extraction effectively eliminated superior vena cava injury. This is a safe and effective technique for transvenous lead extraction.
经静脉起搏器和除颤器导联拔除术是一种风险较高的手术，其首选技术存在差异。该手术的一种常见致死性并发症是上腔静脉穿孔。我们开发了一种串联股静脉-上腔静脉技术，该技术将股静脉入路对目标导联的套扎与从上腔静脉经锁骨下静脉推送的旋转切割鞘结合使用。
我们旨在评估串联股静脉-上腔静脉方法用于导联拔除的安全性和有效性。
连续纳入至少 1 例植入时间≥1 年的起搏器或除颤器导联拔除术患者，这些患者使用串联股静脉-上腔静脉技术作为初始拔除策略。该注册研究涵盖了 2010 年至 2018 年期间由一名主要术者进行的手术。
共纳入 131 例患者。共靶向拔除 267 根导联，平均植入时间为 9.8 年，其中 90 根为除颤器导联（33.7%）。无上腔静脉穿孔或其他血管损伤发生。临床操作成功率为 96.2%。有 5 例严重并发症（3.8%的患者），其中 3 例为需要干预的心包积液。无死亡病例。
串联股静脉-上腔静脉方法用于导联拔除可有效消除上腔静脉损伤。这是一种用于经静脉导联拔除的安全有效的技术。
