Zweiker David, Melillo Francesco, D'Angelo Giuseppe, Radinovic Andrea, Marzi Alessandra, Cianfanelli Lorenzo, Altizio Savino, Limite Luca R, Paglino Gabriele, Frontera Antonio, Nakajima Kenzaburo, Brugliera Luigia, Malatino Lorenzo, Della Bella Paolo, Mazzone Patrizio
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute Vita-Salute University and San Raffaele Hospital Milan Italy.
Third Clinical Department for Cardiology and Intensive Care Klinik Ottakring Vienna Austria.
J Arrhythm. 2022 Feb 4;38(2):192-198. doi: 10.1002/joa3.12677. eCollection 2022 Apr.
Temporary pacing is necessary in pacemaker-dependent patients after transvenous lead extraction (TLE) for cardiac implantable electronic device infection. In case of unavailability of other accesses, we propose to use the ipsilateral subclavian access (ISA) combined with a standard permanent active fixation lead for the temporary pacemaker and present preliminary data.
We consecutively enrolled patients undergoing TLE who received a temporary pacemaker using the ISA between August 2016 and April 2020 at our centre.
During the observation period, 36 patients undergoing TLE for pocket infection (72.2%), endocarditis (25.0%) or other causes received a temporary pacemaker over the ISA. Their mean age was 77.0 ± 10.7 years, and 13.9% were female. Complete TLE was achieved in 94.4%. There were no major periprocedural complications. Intra-hospital mortality was 11.1%. Pocket revision was performed in 19.4%. During long-term follow-up (23 ± 13 months), 8.3% had a relapse of local pocket infection and 2.8% needed rehospitalization for reintervention.
Temporary pacing using a standard permanent active fixation lead using the ISA is a convenient alternative to conventional venous accesses. However, risks of implanting a lead into a previously infected area have to be taken into account.
对于因心脏植入式电子设备感染而进行经静脉导线拔除术（TLE）的起搏器依赖患者，临时起搏是必要的。在无法获得其他通路的情况下，我们建议使用同侧锁骨下通路（ISA）结合标准的永久性主动固定导线来进行临时起搏，并展示初步数据。
我们连续纳入了2016年8月至2020年4月在我们中心接受TLE并使用ISA植入临时起搏器的患者。
在观察期内，36例因囊袋感染（72.2%）、心内膜炎（25.0%）或其他原因接受TLE的患者通过ISA植入了临时起搏器。他们的平均年龄为77.0±10.7岁，女性占13.9%。94.4%的患者成功完成了TLE。围手术期无重大并发症。院内死亡率为11.1%。19.4%的患者进行了囊袋修复。在长期随访（23±13个月）期间，8.3%的患者局部囊袋感染复发，2.8%的患者因再次干预需要再次住院。
使用ISA结合标准的永久性主动固定导线进行临时起搏是传统静脉通路的一种便捷替代方法。然而，必须考虑将导线植入先前感染区域的风险。
