Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN.
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (M.A.).
Circ Arrhythm Electrophysiol. 2022 Jul;15(7):e010744. doi: 10.1161/CIRCEP.121.010744. Epub 2022 Jun 28.
Optimal management of cardiac implantable electronic devices (CIEDs) in patients with Ebstein anomaly during tricuspid valve (TV) surgery is unknown. Thus, we aimed to characterize CIED management/outcomes in patients with Ebstein anomaly undergoing TV surgery.
Patients at the Mayo Clinic from 1987 to 2020 with Ebstein anomaly and CIED procedure were reviewed for procedural details, complications, echocardiogram, and lead parameters. Five-year cumulative incidence of CIED complications were estimated using the Kaplan-Meier method.
Ninety-three patients were included; 51 were female, and mean age was 40.7±17.5 years. A new CIED was implanted in 45 patients at the time of TV surgery with the majority receiving an epicardial (n=37) CIED. Among 34 patients who had preexisting CIED (11 epicardial, 23 transvenous) at time of TV surgery, 20 had a transvenous right ventricular lead managed by externalizing the lead to the TV (n=15) or extracting the transvenous lead with epicardial lead implantation (n=5). Fourteen patients underwent CIED implantation (4 epicardial, 10 transvenous) without concurrent surgery. Placement of lead across the TV was avoided in 85% of patients. The 5-year cumulative incidence of CIED complications was 24% with no significant difference between epicardial and transvenous CIEDs (26% versus 23%, =0.96). Performance of lead parameters was similar in epicardial and transvenous leads during median (interquartile range) follow-up of 44.5 (61.1) months.
In patients with Ebstein anomaly undergoing TV surgery, the use of epicardial leads and externalization of transvenous leads to the TV can avoid lead placement across the valve leaflets. Lead performance and CIED complications was similar between epicardial and transvenous CIEDs.
在三尖瓣（TV）手术中，心脏植入式电子设备（CIED）在Ebstein 畸形患者中的最佳管理方法尚不清楚。因此，我们旨在描述接受 TV 手术的 Ebstein 畸形患者的 CIED 管理/结局。
回顾了 1987 年至 2020 年在 Mayo 诊所接受 Ebstein 畸形和 CIED 手术的患者的手术细节、并发症、超声心动图和导线参数。使用 Kaplan-Meier 法估计 CIED 并发症的 5 年累积发生率。
共纳入 93 例患者，其中 51 例为女性，平均年龄为 40.7±17.5 岁。45 例患者在 TV 手术时植入新的 CIED，其中大多数接受经皮（n=37）CIED。在 34 例 TV 手术时存在原有 CIED（11 例经皮，23 例经静脉）的患者中，20 例经静脉右心室导线通过将导线外置到 TV（n=15）或经皮导线提取与经皮导线植入（n=5）进行管理。14 例患者在没有同期手术的情况下植入 CIED（4 例经皮，10 例经静脉）。85%的患者避免了导线穿过 TV。CIED 并发症的 5 年累积发生率为 24%，经皮和经静脉 CIED 之间无显著差异（26%比 23%，=0.96）。在中位（四分位距）44.5（61.1）个月的随访中，经皮和经静脉导线的导线参数性能相似。
在接受 TV 手术的 Ebstein 畸形患者中，使用经皮导线和将经静脉导线外置到 TV 可以避免导线穿过瓣叶。经皮和经静脉 CIED 的导线性能和 CIED 并发症相似。
